bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14598: Predictive Value of the High Bleeding Risk Criteria of the Academic Research Consortium in Black and White Individuals
Authors: Cohen Rebecca , Spirito Alessandro , Sartori Samantha , Vogel Birgit , Pileggi Brunna , Pentousis Paris , Smith Kenneth F , Sharma Samin K , Kini Annapoorna , Dangas George , Mehran Roxana , Zhang Yujin
Published: December 2023

Introduction:
The High Bleeding Risk (HBR) criteria of the Academic Research Consortium (ARC) are a valuable tool for bleeding risk stratification in White and Asian patients undergoing percutaneous coronary intervention (PCI).

Hypothesis:
The predictive value of the ARC-HBR criteria may vary in Black patients.

Methods:
Patients who underwent PCI at a large tertiary-care center from 2012 to 2019 who self-reported as non-Hispanic White or Black were included and stratified in HBR and no-HBR based on the ARC-HBR definition. The primary outcome was major bleeding (according to a study specific definition) at 1 year after PCI; secondary outcomes included post-discharge major bleeding, all-cause death and myocardial infarction (MI).

Results:
Among 9462 patients, 1881 (19.9%) identified as Black and 7581 (80.1%) as White. In these two groups, the HBR criteria were met by 50.8% and 45.6% of patients, respectively, and the frequency of each individual ARC-HBR criterion differed (Figure 1). HBR was associated with a consistent higher risk of major bleeding in Black (7.8% vs. 3.5%, adj. HR 2.02, 95% CI 1.29-3.17) and White patients (7.5% vs. 2.7%, adj. HR 2.49, 95% CI 1.95-3.18, interaction p-value 0.451) (Figure 1). The HBR-related risk of post-discharge bleeding tended to be higher in Black patients (adj. HR 1.67, 95% CI 0.84-3.33) and was significantly increased in White patients (adj HR 3.09, 95% 2.06-4.64, interaction p-value 0.341). All-cause death and MI were increased in HBR patients consistently in the Black and the White group. The predictive value of the ARC-HBR criteria for major bleeding and post-discharge bleeding was good in both Black (0.72 and 0.74, respectively) and White (0.70 and 0.68, respectively).

Conclusions:
In Black and White patients undergoing PCI, the ARC-HBR criteria were differently distributed and had a good predictive value for major bleeding in both groups.
Abstract 14611: Default Bulk Ordering and Text Messaging to Enhance Outreach for Lipid Screening
Authors: Pollak Catherine , Parambath Andrew , Coratti Samantha , Norton Laurie , Reitz Catherine , John Aileen , Volpp Kevin , Mehta Shivan
Published: December 2023

To reduce atherosclerotic cardiovascular disease (ASCVD) risk, the American College of Cardiology/American Heart Association recommends routinely assessing traditional cardiovascular risk factors and calculation of 10-year ASCVD risk for adults 40-75 years of age and traditional ASCVD risk factors for adults 20-39 years of age at least every 4-6 years. For many patients, the ASCVD risk can’t be calculated due to a missing comprehensive lipid panel. In our health system, 23% of adult patients had not had labs within the past 5 years. We aim to evaluate the effect of behavioral economic interventions on lipid screening uptake. We hypothesize that reducing effort for patients and clinicians through default bulk ordering and salient communication through outreach letters with PCP endorsement, time-limited components and physical lab orders will result in greater completion of lipid screening compared to usual care (H1), and that increased salience through additional complementary communication (text message reminders and scheduling assistance) will result in higher response rates compared to usual care, and bulk order and outreach alone (H2). Results from a mini-pilot on 100 patients indicated that bulk ordering and text message concierge service increased response rate (21%) compared to conventional outreach (12%) or bulk-ordering only (9%). We are conducting a pragmatic randomized clinical trial among patients from two primary care practices at an academic health system. Eligible patients aged 20-75 years and overdue for a lipid panel are randomized to 3 intervention arms (N=1,000,1:2:2 ratio): usual care (1), outreach and bulk orders (2), outreach, bulk orders and text message reminders (3). The primary outcome is the completion of the lipid panel within 3 months. Secondary outcomes include completion of the lipid panel within 6 months, the number of patients with an elevated ASCVD risk score and the number of patients who receive statin prescription due to this information. Results from the pilot trial launching in June 2023 are forthcoming. They will provide data that can be used to design future interventions that test the use of various behavioral economic tools to increase completion of lab tests, a necessary input into calculation of patient risk.
Abstract 14622: The Effects of SGLT2 Inhibitor Therapy in Patients With Non-Compaction Cardiomyopathy
Authors: Cerar Andraz , Jaklic Martina , Frljak Sabina , Okrajsek Renata , Zorz Neza , Poglajen Gregor , Zemljic Gregor , SEBESTJEN Miran , Vrtovec Bojan
Published: December 2023

Introduction:
Current therapeutic options in patients with noncompaction cardiomyopathy (NCC) are very limited. Recent evidence suggests that sodium glucose co-transporter 2 inhibitors (SGLT2i) may be effective across the spectrum of heart failure.

Hypothesis:
We sought to analyze the effects of SGLT2i on cardiac function in patients with NCC.

Methods:
We have prospectively enrolled 30 (23 male, 7 female) patients with NCC, confirmed by cardiac MRI from 2020 to 2022. Clinical, biochemical and echocardiography data were obtained at SGLT2i introduction and 6-month follow-up. On inclusion the patients were on stable HF therapy; dapagliflozin 10mg was prescribed to 23 patients, empagliflozin 10 mg to 7 patients. On follow-up echo myocardial recovery was defined as an increase of left ventricle ejection fraction (LVEF) ≥5%.

Results:
During follow-up, we found significant improvements in LVEF (29.8±7.5% vs. 43.5±9,5%; P<0.001), LVOT VTI (14.3±7.5cm vs. 17.6±9.7cm; P=0.005), E/e' (15.7±6.4 vs. 10,0±4.1, P<0.001) and TAPSE (2.0±0.4 vs. 2.3±0.4, P=0.012). NT-proBNP levels also decreased significantly (2843±3302 pg/mL vs. 582±803 pg/mL; P=0.002). A total of 18 (60%) of patients showed signs of myocardial recovery (Group A), whereas 12 (40%) showed no significant LVEF improvement (Group B); 5 patients had an event during follow-up (1 sudden cardiac death, 4 had heart Tx or LVAD implantation performed). The two groups did not differ significantly in age (50±15 vs. 46±15 years, P=0.54), sex (67% vs. 83 % male, P=0.28), baseline creatinine (83.3±27 μmol/Lvs. 89.3±21 μmol/L, P=0.53) or bilirubine (21±15 μmol/L vs. 17±12 μmol/L, P=0.56). When compared to Group B at inclusion, Group A had smaller EDD (6.4±0.8 cm vs. 7.1±0.9 cm in Group B, P=0.025), lower NTproBNP levels (1720±1662 pg/mL vs. 4527±4397 pg/mL, P=0.02), lower γGT levels (0.7±0.5 μkat/L vs. 1.4±1.1 μkat/L, P=0.017) and lower incidence of atrial fibrillation (11% vs. 57% in Group B, P=0.032).

Conclusions:
In patients with NCC, the introduction of SGLT2i appears to be related to significant myocardial recovery. The improvement may be more pronounced in NCC patients with smaller LV diameter, less neurohormonal activation, better hepatic function and lower incidence of atrial fibrillation.
Abstract 14629: Assessing the Contribution of Racial Differences in Elevated Lipoprotein (a) Levels to Disparities in Atherosclerotic Cardiovascular Disease: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Grant Jelani K , Martin Seth S , Zhang Sui , Matsushita Kuni , Virani Salim S , Blumenthal Roger S , Hoogeveen Ron C , Boerwinkle Eric , Ballantyne Christie M , Coresh Josef , Ndumele Chiadi E
Published: December 2023

Introduction:
Racial differences in Lp(a) distributions are well known, with higher levels in Black adults compared to White adults. It is unclear whether the risk implications of higher Lp(a) levels are the same in Black and White adults. Furthermore, the contribution of racial differences in Lp(a) to disparities in ASCVD in the US has not been well characterized in long-term cohort studies.

Objective:
We evaluated the relative risk associations for higher Lp(a) and estimated the related population-attributable fraction (PAF) for ASCVD in Black and White adults.

Methods:
We performed a prospective analysis of 9,519 Black and White participants at ARIC Visit 4 (1996-1999) without baseline ASCVD. Plasma Lp(a) was measured from stored Visit 4 plasma samples using an apo(a) isoform-insensitive assay (Denka Seiken). Lp(a) was categorized as <30, ≥30 to <50, 50≥ to <100 and ≥100 mg/dL. We assessed the association of higher Lp(a) categories with incident coronary heart disease (CHD) and ASCVD (CHD and ischemic stroke) overall and stratified by race, with tests for interaction. We calculated the PAF for ASCVD and CHD associated with Lp(a) ≥30 mg/dL, overall, and for Black and White adults.

Results:
The mean age was 63±6 years, with 59% women and 23% Black adults. There was a higher prevalence of Lp(a)
>
30 mg/dL among Black than White adults (54 vs 24%). During a follow-up of 24 years, there were 2,235 ASCVD and 1,715 CHD events. Higher Lp(a) categories were associated with progressively higher risk, with Lp(a) ≥100 mg/dL associated with hazard ratios of 1.71 (95% CI 1.38-2.12) for ASCVD and 1.67 (1.30-2.13) for CHD, with no significant differences by race (Table). The PAF associated with elevated Lp(a) was two times higher in Black than White adults for ASCVD (10.7 vs 4.7%) and CHD (10.5 vs 4.3%).

Conclusion:
Differences in Lp(a) distributions likely contribute to racial disparities in ASCVD. Evolving therapies targeting Lp(a) lowering could assist in addressing disparities in ASCVD.
Abstract 14630: Young Female Presenting With Chest Pain Due to Left Main Aneurysm
Authors: Bharaj Inderjeet Singh , Thorpe Kirk , Al Rabadi Oday A
Published: December 2023

Background:
Incidence of ACS is increasing in young patients. While atherosclerosis needs to be ruled out, there should be high suspicion for alternate causes.

Case:
A 36-year-old African American woman with obesity, prediabetes and tobacco use, presented to the ED with chest pain. Initial cardiac investigations unremarkable. CTA chest ruled out pulmonary embolism and aortic dissection. Her pain had resolved and she was discharged home. Within hours, the pain recurred and became progressively worse. She returned to the ED and was found to have an anterior STEMI with a troponin I 0.72 ng/ml. Cardiology was consulted, left heart cath revealed a large left main aneurysm (LMA) with large thrombus burden, with mildly aneurysmal LAD, RCA and LCx, moderate decrease in systolic function and no significant arch or main vessel aneurysms. Case was discussed with cardiothoracic surgery, who recommended medical management. Her symptoms resolved while on anticoagulation.

Discussion:
Coronary artery aneurysms (CAA) are a rare cause of ACS. The reported incidence of CAA ranges from 0.3% to 5%, most often affecting men. The RCA is the most commonly affected artery followed by the LAD, with the LM being the least common. Risk factors include hypertension, dyslipidemia, smoking, diabetes, and a family history of coronary artery disease. Known etiologies include atherosclerosis, Kawasaki disease, inflammatory, congenital, and degenerative conditions. Transient myocardial ischemia may result from aneurysm-related blood stasis that may predispose to thromboembolic events, coronary spasm, and microvascular dysfunction.

Conclusion:
Although considered extremely rare, the number of LMA reported has increased in the last decades and may continue to grow with the widespread use of invasive and noninvasive coronary imaging. Considering the rarity of CAA and absence of dedicated studies, both the interventional and the pharmacological management of patients with LMA are challenging.
Abstract 14650: Risk Stratifying Individuals With Zero, Minimal, and Mild Coronary Artery Calcium for Cardiovascular Disease by Determining Coronary Plaque Burden
Authors: Ansari Salman , Pourafkari Leili , Kinninger April , Budoff Matthew J
Published: December 2023

Background and Aims:
Previous research has often categorized minimal CAC (1-10) and 0 CAC into a single low-risk category for CVD. However, the clinical significance of plaque burden between these two groups remains unclear. We sought to determine the plaque burden in individuals with CAC scores of 0, 1-10, and 11-100 to specify a more accurate risk stratification for minimal and 0 CAC scores.

Methods:
Retrospectively reviewed patients with CAC scores ≤100 and performed quantitative coronary plaque analysis (QAngio, Medis). CAC was categorized into three groups: zero (CAC=0), minimal (CAC 1-10), and mild (CAC 11-100). Plaque levels (low attenuated, fibrous, fibro-fatty, dense calcified, total non-calcified) were assessed using multivariable linear regression adjusted for cardiovascular risk factors (age, ethnicity, BMI, gender, hypertension, dyslipidemia, diabetes mellitus, past smoking)

Results:
378 subjects were included, with an average age of 53.9±10.7 years and 53% female. Among them, 51% had 0 CAC, 16% had minimal CAC (scores 1-10), and 33% had mild CAC (scores 11-100). The minimal and mild CAC groups were significantly older, with higher rates of diabetes, hypertension, and hyperlipidemia. Multivariable analysis found no significant difference in low attenuated, fibro-fatty, and dense calcified plaque levels between the minimal and 0 CAC groups. However, minimal CAC subjects had significantly higher fibrous, total non-calcified, and total plaque volumes than zero CAC (
Table 3
). All plaque types were significantly higher in the mild group when comparing mild CAC to minimal CAC."

Conclusion:
This study shows higher noncalcified coronary plaque and total plaque volume in individuals with minimal calcium scores (1-10) compared to those with 0 CAC. These findings hold clinical significance, challenging previous categorization of minimal CAC as low-risk. Therefore, those with minimal CAC scores need a more accurate risk stratification approach.
Abstract 14656: Virtual Cardiac Rehabilitation is Rarely Used but May Augment Overall Attendance
Authors: Fu Whitney , Hou Hechuan , Likosky Donald S , McCullough Jeffrey , Sukul Devraj , Keteyian Steven J , Ellimoottil Chad , Thompson Mike P
Published: December 2023

Introduction:
The COVID-19 public health emergency temporarily expanded Medicare reimbursement of cardiac rehabilitation (CR) to cover virtual CR. The purpose of this study was to evaluate the frequency of virtual CR use in Medicare and describe this emerging population of virtual CR patients, as there is currently limited data on the rates and patterns of virtual CR utilization.

Methods:
The study sample included 100% of Medicare beneficiaries undergoing surgical/percutaneous coronary revascularization or aortic valve replacement between July 2019 and December 2021 in the Medicare Virtual Research Data Center. Professional claims were used to identify CR use within one year of discharge using CPT codes (93797, 93798), and the disaster-related modifiers (“CR” or “DR”) were used to categorize CR visits as synchronized virtual sessions. Descriptive analysis compared patient characteristics and number of CR sessions attended between patients using virtual and facility-based CR.

Results:
Overall CR use was 32.5% in the entire sample (167066/513735). Any CR use was more prevalent among patients who were male, White, or 65-85 years old, and similar between coronary revascularization vs. aortic valve procedures. Only 14 states reported any virtual CR visits (CA, FL, GA, IL, IN, MI, MN, MO, NY, OR, PA, TN, TX, WI). Within these states, only 1% (886) of all CR users had at least one virtual CR session. The characteristics of patients who utilized virtual CR were largely similar to those who attended facility-based only CR. The median number of virtual sessions was 21 (IQR 26). Of patients who utilized virtual CR, 17.7% (157) also attended at least one facility-based CR session. Notably, combined virtual and facility-based CR utilizers attended a median of 33 (IQR 14) total CR sessions, compared to 25 (IQR 23) CR sessions for patients who attended only facility-based CR.

Conclusion:
Virtual CR was not widely available or used despite expanded Medicare reimbursement, yet our data suggests that the combined use of virtual and facility-based CR may be associated with a greater number of sessions attended (vs. facility-based only CR). Further research is needed to inform long-term policy decisions, particularly as it pertains to continued Medicare coverage of virtual CR.
Abstract 14659: Muscle Oxygenation Responses to Acute Exercise and Cellular Biomarkers of Vascular Health in Veterans With Chronic Kidney Disease
Authors: Gollie Jared M , Nandula Seshagiri R , Kim David J , Jain Arad , Argaw Abel , Singarapu Tharangini , patel samir , Cohen Scott D , Kokkinos Peter F , Blackman Marc R , Sen Sabyasachi
Published: December 2023

Introduction:
Increased susceptibility of endothelial dysfunction and skeletal muscle impairments suggest peripheral limitations as an explanation for diminished aerobic capacity in chronic kidney disease (CKD) patients. However, data on peripheral limitations in CKD patients is limited.

Hypothesis:
We hypothesized CKD patients would experience reduced muscle oxygenation responses to acute exercise and cellular evidence of declines in vascular health compared to those without CKD.

Methods:
Sixteen male Veterans (CKD: n=9, age 74±6 yrs, eGFR, 41.7±10 mL/min/1.73 m
2
; non-CKD controls (CON): n=7, age, 67±8 yrs, eGFR, 75±10.6 mL/min/1.73 m
2
) completed treadmill cardiopulmonary exercise testing via the Modified Bruce protocol. Oxygenation responses were obtained from the medial gastrocnemius using near-infrared spectroscopy. Blood samples were collected at rest and analyzed for colony-forming units (CFU), flow-cytometry of mononuclear cells (MNCs) focusing on endothelial lineage cells and gene expression of MNCs. Effect sizes between groups were determined using Hedge’s g (g).

Results:
At peak exercise, oxygen consumption (VO
2peak
19±5 vs 25.8±5.2 ml/kg/min
-1
, g=1.2), heart rate (HR
peak
132±21 vs 160±9 bpm, g=1.6), oxygen extraction (Δ[HHb] 14.8±10.8 vs 24.9±6.8 a.u., g=1.0), and change in total hemoglobin concentration (Δ[tHb] 8.9±5.1 vs 22.5±12.8 a.u., g=1.4) were lower in CKD compared to CON. At an exercise intensity of 3.4 METs, Δ[HHb] and Δ[tHb] were 42% and 54% lower (8.0±7.8 vs 13.8±8.8 a.u., g=0.6 and 4.9±4.1 vs 10.7±4.5 a.u., g=1.2) in CKD vs CON, despite no differences in oxygen consumption or heart rate. CD34
+
184 expression was 47% lower in CKD vs CON (0.2±0.04 vs 0.38±0.48 %, g=0.5). CFU was significantly inversely correlated with body mass index and waist circumference (r=-0.67, p=0.034; r=-0.65, p=0.041).

Conclusions:
Preliminary data from this ongoing study suggest oxygen extraction and capillary blood volume expansion are impaired during exercise in CKD patients when compared to those without CKD. CD34
+
184 expression was lower in CKD patients versus those without CKD, indicating poor hematopoietic stem cell migratory function in the CKD group. In addition, an inverse association between CFU and body habitus was observed.
Abstract 14708: Heart Failure While Homeless: Examining the Relationship Between HF Hospitalizations and Housing Insecurity
Authors: Webb Martine S , Ziaeian Boback
Published: December 2023

Background:
The association between housing insecurity and outcomes of hospitalizations for heart failure (HF) has not been previously well-established.

Methods:
We analyzed HF hospitalizations using the 2020 United States National Inpatient Sample database. Individuals were identified as having housing insecurity by related ICD-10 codes. Other demographic and comorbidity data were identified using corresponding ICD-10 codes. Characteristics of patients hospitalized for HF that were identified as having housing insecurity were compared to those hospitalized for HF who had no housing insecurity. We performed a multivariable risk adjustment for in-hospital mortality based on patient characteristics.

Results:
Out of 1,003,270 hospitalizations for HF, 16,150 were identified as having housing insecurity (1.6%). The average age of patients with housing insecurity hospitalized for HF was 56, as compared to 71 in the housed population. A higher proportion of patients in the housing-insecure group were Black (35% vs 20.1%) or Hispanic (11.1% vs 7.3%). Patients with housing insecurity were more likely to carry a diagnosis of alcohol use disorder (15.2% vs 3.3%) or substance use disorder (70.2% vs 17.8%), however they were less likely to use tobacco (18.3% vs 28.7%). Patients with housing insecurity were over 4.5 times more likely to have a primary Medicaid payer (52.4% vs 11.3%). Average length of stay did not differ between housing-insecure patients versus those without (5.37 vs 5.51 days). After adjusting for patient characteristics, housing insecurity was predictive of lower in-hospital mortality (OR 0.622, 95% CI 0.403 - 0.960).

Conclusions:
Significant differences occur between patients hospitalized for HF who also have housing insecurity. These differences are most pronounced for substance use and psychiatric disorders. However, housing insecurity was predictive of lower in-hospital mortality. Admissions for heart failure may provide important opportunities to screen for and address comorbid conditions for patients with housing insecurity, as well as for other vulnerable populations.
Abstract 14730: The Effect of Electronic Cigarette Exposure With Nicotine on Expression of Inflammatory Genes and Blood Parameters in a Chronic Myocardial Infarction Model
Authors: Shi Jianru , Dai Wangde , Carreno Juan , Kleinman Michael T , Herman David , Johnson Rebecca , Renusch Samantha , Hasen Irene , Ting Amanda , Kloner Robert A
Published: December 2023

Background:
There are no data available regarding the effects of chronic electronic cigarette (eC) exposure on inflammatory gene expressions after myocardial infarction (MI) and whether eC could alter blood counts and chemistries in this setting. We determined the effect of eC on expression of genes for inflammatory cytokines and receptors and blood parameters during the healing phase of MI.

Methods and Results:
Sprague Dawley rats of either sex were subjected to a proximal left coronary artery occlusion to induce a large anterior wall MI. At 1 week, rats were randomized to exposure to air or E-cig with nicotine (eC Nic
+
) for 12 weeks. After 12 weeks of exposure, rat inflammatory cytokine and receptor PCR array was performed (n=4 in each group). The data showed 70 out of 84 inflammatory-related genes were downregulated in the eC Nic+ group versus the air group and 11 downregulated genes reached a significant difference. Interleukin 6 (IL6), Tumor necrosis factor superfamily (TNF), Chemokine (C-C motif) ligand 12 (Ccl12), and C-X-C Motif Chemokine Receptor 3 (Cxcr3) gene expressions were significantly decreased by -6.49 fold, p=0.0048, -2.63 fold, p=0.0227, -2.71 fold, p=0.0146, and -2.28 fold, p=0.0067, respectively, in the eC Nic+ group vs air group. The rats in eC Nic+ group had significantly decreased white blood cell (WBC), lymphocyte and platelet count compared to the air group (Figure).

Conclusions:
Exposure to eC Nic+ alters the expression of inflammatory genes and decreases blood immune cells during the healing phase of MI. Our findings suggest that chronic inhalation of e-cigarette aerosols can suppress the immune and inflammatory response in the already compromised setting of MI.
Abstract 14744: Driving Distance to a Primary Cardiac Center is Associated With Mortality in Patients With Tetralogy of Fallot Undergoing Neonatal Interventions
Authors: Nunez Gallegos Flora , Maskatia Shiraz A , Zampi Jeffrey , Nicholson George , Zhang Yun , McCracken Courtney , Mascio Christopher , Petit Christopher J , Romano Jennifer , Zanaboni Dominic , Obyrne Michael L , Nanduri Alekhya , Wong-Siegel Jeannette , Law Mark A , Hock Kristal M , Shahanavaz Shabana , Batlivala Sarosh P , Speed Sarah , Meadows Jeffery J , Qureshi Athar Mahmood , Taleb Mariam , Khan Hala , Ligon Allen , Glatz Andrew C , Lopez Keila N
Published: December 2023

Introduction:
Advances in tetralogy of Fallot care have improved survival, however, associations of sociodemographic disparities and mortality are less well described, particularly among patients with symptomatic tetralogy of Fallot (sTOF) requiring neonatal intervention. Our multicenter Congenital Cardiac Research Collaborative (CCRC) study investigated sociodemographic factors associated with mortality in sTOF patients.

Hypothesis:
Sociodemographic factors related to a lower socioeconomic status are associated with increased mortality in patients with sTOF.

Methods:
Retrospective cohort study of neonates with sTOF receiving surgical or catheter-based palliation or primary repair at <30 days old from 1/2005 - 11/2017 at one of nine U.S. centers in the CCRC. Primary outcome variable was mortality at last follow up. Primary predictor variable was childhood opportunity index (COI), a national composite score based on 29 neighborhood-level indicators of poor vs excellent health. Secondary predictor variables included distance to primary cardiac center, race/ethnicity, and maternal insurance type. Sociodemographic factors were evaluated using multivariable Cox proportional hazard models, adjusting for center and patient anatomic and genetic characteristics resulting in hazard ratios (HR) with 95% CI.

Results:
There were 417 neonates with sTOF, with an overall follow-up mortality of 10% at median follow-up of 4.8 years (25th - 75th %ile: 2.1 - 8.2). Most patients were male (53%), non-Hispanic White (52%), prenatally diagnosed (58%), and had public insurance (54%). On adjusted multivariable analysis, infants >100 miles from a primary heart center had a 3x higher hazard of mortality (HR 2.94; 95% CI, 1.13-7.61; p=0.026) compared to those living <50 miles from a heart center. All other sociodemographic factors (COI, race/ethnicity, and insurance type) were not significantly associated with mortality on multivariable analysis.

Conclusions:
Proximity to a specialized pediatric cardiac center remains a significant determinant of survival in neonates with sTOF, emphasizing the importance of access to cardiac care. Sociodemographic impact on patient morbidity and lifelong mortality in TOF requires further investigation.
Abstract 14747: MS Gene: Multistate Modeling of Dynamic Lifetime Risk of Coronary Artery Disease Using Electronic Health Records in the UK Biobank
Authors: Urbut Sarah , Yeung Ming Wai , Schuermans Art , Cho So Mi J , HORNSBY WHITNEY , Fahed Akl , Parmigiani Giovanni , Trinquart Ludovic , Gusev Alexander S , Natarajan Pradeep
Published: December 2023

Introduction:
Estimated lifetime risk for coronary artery disease (CAD) is an essential goal, yet few tools exist to dynamically update predictions with age-dependent effects.

Methods:
We considered 221,997 individuals (54% female) followed in the UK Biobank (UKB) Electronic Health Record (EHR) and GP (general practice) since adulthood (median entry age 24, IQR 18-37). We built a multi-state model for dynamic risk, MSGene, comprised of 10 time-dependent states based on cardiometabolic conditions. We report annual state transitions to CAD as age-dependent functions of sex, polygenic score (PRS) and smoking. We evaluate prediction relative to the Pooled Cohort Equations (PCE) for 10-year risk and to empiric values for lifetime risk. We report age-specific absolute risk reduction by integrating yearly relative reduction using imputation from randomized statin trials.

Results:
MSGene improved accuracy (root mean squared error [RMSE] 0.85% vs 6.56%, P<0.001) compared with PCE for 10-year risk, and has RMSE of 2.6% [SEM 0.0067] for lifetime risk (
Figure 1a
) when compared to empirical rates after validation. The relative effect of PRS on transition from health is greater earlier in life (
Figure 1b
). MSGene reinforced that individuals with low short-term risk are at high lifetime predicted risk: a healthy non-smoking male at the 80
th
percentile PRS with a 2.4% (10-year) risk at age 40 has a 23.6% lifetime risk (
Figure 1c
). MSGene nimbly models dynamic transitions (
Figure 1D
): for example, for individuals with hypertension, these increase to 5.6% and 35% (SEM 0.02) respectively. Under statin therapy, predicted absolute risk reduction for those at the highest genetic risk declines from 5.9% [5.85-5.94] at age 40 to 2.8% [2.78-2.92] at age 70.

Conclusions:
We introduce a novel statistical method, MSGene, which accurately describes the age-dependent risk of developing CAD over the lifespan conditional on PRS and updated health status, for adaptive prevention and screening.
Abstract 14760: Elevated Heart Rate at Diagnosis is Associated With Adverse Outcomes in Peripartum Cardiomyopathy
Authors: Berkowitz Julia , Sagaityte Emilija , Arany Zoltan , Bello Natalie A , Choudhary Gaurav , Djousse Luc , French Katharine , Joseph Jacob , Khalid Mahnoor , Lopez Diana , Mohebali Donya , Poppas Athena , Sabe Marwa , Wu Wen-Chih "Hank" , Imran Tasnim F
Published: December 2023

Introduction:
Understanding predictors of adverse outcomes in patients with peripartum cardiomyopathy (PPCM) is essential to inform clinical practice and improve outcomes.

Aim:
The aim of this study is to examine the relationship between heart rate (HR) at diagnosis and adverse outcomes in PPCM.

Methods:
We conducted a multi-center cohort study to identify patients with PPCM (1993-2017) who met the inclusion criteria: left ventricular ejection fraction (LVEF) <40%, development of heart failure within the last month of pregnancy or 5 months of delivery, and no other identifiable cause of heart failure with reduced ejection fraction. The primary composite outcome of major adverse events included heart failure hospitalization, need for extra-corporeal membrane oxygenation, left ventricular assist device, orthotopic heart transplant, or all-cause death. Using Cox proportional hazards models, we examined the relationship between categories of HR at diagnosis and adverse outcomes.

Results:
A total of 177 women met criteria (81 with HR <100bpm, 54 with HR 100-119bpm, 42 with HR ≥120bpm) with a mean age of 33 ± 7 years and median follow up 3.4 years (IQR 1.0-8.8); 48 (27%) experienced the composite outcome. In a multivariable model adjusting for age, race, preeclampsia or hypertension, women with HR ≥ 120 bpm were four times more likely to experience major adverse events compared to women with HR < 100 bpm (HR 4.1, 95% CI 1.6- 10.4). HR was significantly associated with LVEF in age adjusted linear regression (F= 39.1, p <0.001). Patients with HR <100 bpm were significantly more likely to have survival free from adverse events in survival analysis (logrank p= 0.03, Fig 1).

Conclusions:
Tachycardia may be an early prognostic indicator of adverse outcomes in PPCM and could identify high risk patients who may benefit from close follow-up and early intervention.
Abstract 14785: HEART Score Utilization - Revisited
Authors: Arora Punit , Cwikla Kamil , Dankha Christine , Sutherland David , Katsouli Anthi
Published: December 2023

Introduction/Background:
Chest pain accounts for approximately 7.6 million visits a year to the Emergency Department (ED) in the US. With use of the HEART score, a validated instrument helps to risk stratify patients with chest pain into low, medium, and high-risk groups. Low risk patients have a 1.6% chance of experiencing a major adverse cardiac event (MACE) within 30 days and are safe discharges from the ED without further testing.

Hypothesis:
We hypothesize that a targeted intervention to educate providers to use the HEART score will lead to decreased testing of low-risk patients without increase in MACE.

Methods:
Targeted interventions: (1) we provided teaching sessions on how to use the HEART score and (2) HEART score template was embedded into admitting notes on the unit EMR.

Via retrospective chart review, investigators calculated a HEART score for patients who presented with chest pain and were admitted to LUMC. We calculated the rate of further cardiac testing and length of stay (LOS) for each risk stratified group, before and after our intervention. Chi-square tests are used to evaluate for association.

Results/Data:
Pre-intervention (n=259), only 30.5% patients had a documented HEART score. 46.7% were low risk, of which 30.5% underwent inpatient stress test or further cardiac testing. Low-risk patients that underwent further workup had increased LOS (p=0.0048). Post intervention (n=79), 58.1% patients had a documented HEART score, a statistically significant increase (p<0.001). Of those considered low risk, fewer had further cardiac testing ordered (p<0.001). No patient with a low-risk HEART score experienced a MACE within 30 days.

Conclusions:
Provider education is an effective method to increase HEART score utilization and reduce inpatient cardiac testing of low-risk patients with chest pain. Our study demonstrated an increase in documentation of the HEART score and a reduction of further testing of low-risk patient groups without worse outcomes.
Abstract 14786: Disparities in Composite Cardiovascular Risk Factor Control in US Adults With Diabetes in the NIH Precision Medicine Initiative All of Us Research Program
Authors: Golden Frances D , Gong Yufan , Wong Nathan D
Published: December 2023

Background/Objective:
There are limited contemporary data in real-world populations on composite cardiovascular risk factor (RF) control in adults with diabetes mellitus (DM). We studied the proportions of patients with DM at target for individual and multiple cardiovascular RFs including HbA1c, LDL-C, BMI, blood pressure, and smoking status.

Methods:
We included adults ≥18 years of age with DM from the NIH Precision Medicine Initiative All of Us Research Program 2018-2022. RFs and target values were defined as 1) HbA1c (<7% w/ atherosclerotic cardiovascular disease (ASCVD) or <8% w/o ASCVD), 2) LDL-C (<55mg/dL w/ ASCVD or <70mg/dL w/o ASCVD), 3) blood pressure (<130/80 mmHg), 4) BMI (<25 kg/m
2
), and 5) smoking status (never or former smoker). We investigated the proportion (%) of patients at target for individual RFs, ≥3 RFs, ≥4 RFs, and mean number at target by sex, race/ethnicity, and ASCVD status.

Results:
Individual and composite cardiovascular RF control was found to be low among the 83,093 participants with DM. Control of
>
3 RFs and ≥ 4 RFs was only 25% and 5% overall, respectively, with fewer than 1% at target for all 5 RFs; female sex, Asian race/ethnicity, and those with prior ASCVD were more likely to have multiple RFs at target. Non-Hispanic black participants had the lowest proportion of RFs at target. In a multiple logistic regression, higher income, higher education level, employment, female sex, and Non-Hispanic White & Asian race/ethnicity positively predicted control of ≥ 4 RFs with p-value < 0.001.

Conclusions:
Individual and composite RF control remains suboptimal in many patients with DM, with disparities across certain demographic subsets. Further efforts are required to address social determinants that may be responsible for continuing gaps in adequate RF control and to educate clinicians and patients on the importance of controlling key RFs that impact ASCVD and other outcomes in those with DM.
Abstract 14809: Macrophages Contribute to Diastolic Dysfunction in Systemic Sclerosis
Authors: Jones Xaviar M , Ciullo Alessandra , Mesquita Thassio , Rogers Russell , Ibrahim Ahmed G , Cingolani Eugenio , Marban Eduardo
Published: December 2023

Introduction:
Systemic sclerosis (SSc) is an autoimmune disease characterized by aberrant inflammation and internal organ fibrosis, resulting in irreversible scarring and organ failure. In patients with SSc, primary cardiac involvement heralds a poor prognosis, and accounts for one-third of SSc-related deaths. No effective treatments are available for this lethal disorder. However, preclinical investigations are hindered by the scarcity of animal models recapitulating human SSc-associated cardiac disease.

Methods:
5-7-week-old C57BL/6J female wild type mice were injected with PBS (control) or 100 μL bleomycin subcutaneously every other day for 4 weeks. Endpoints include body weight, exercise capacity, echocardiography, and histologic quantification of fibrosis in heart (Masson’s trichrome staining).

Results:
At study endpoint, animals receiving bleomycin exhibited body weight loss (p<0.005) and lower exercise capacity compared to vehicle (p<0.0002). Echocardiographic assessment revealed diastolic dysfunction (measured by E/E’ ratio) in bleomycin exposed mice (38.35 vs 21.38 control; p<0.001), with no changes in systolic function. By Masson’s trichrome staining, cardiac fibrosis was significantly greater in SSc animals compared to controls (p<0.001). Transcriptomic analysis of left ventricular tissue from SSc mice showed enrichment of macrophage signaling pathways. Furthermore, macrophage depletion (for 4 weeks post bleomycin) with clodronate liposomes attenuated diastolic dysfunction (-10.48; p p<0.01) and cardiac fibrosis (p<0.05) in SSc mice compared to vehicle.

Conclusions:
The bleomycin model of systemic sclerosis also exhibits signs of systemic sclerosis with cardiac involvement, namely diastolic dysfunction and myocardial fibrosis. The clodronate data implicate inflammation and specifically macrophages as drivers of cardiac abnormalities in this preclinical model of SSc.
Abstract 14810: ASCVD Risk Score vs Machine Learning-Based Algorithm in the Prediction of ASCVD Events in Women With Breast Cancer
Authors: Stabellini Nickolas , Blumenthal Roger S , Bittencourt Marcio S , Whelton Seamus P , Leong Darryl , Moore Justin , Cullen Jennifer , Nain Priyanshu , Shanahan John , Dent Susan F , Montero Alberto , Guha Avirup
Published: December 2023

Introduction:
Cancer patients may face an elevated risk of developing atherosclerotic cardiovascular disease (ASCVD). Consequently, a conventional pooled cohort equation may not accurately predict cardiovascular (CV) outcomes in this population.

Hypothesis:
A cancer-specific algorithm is superior to conventional ASCVD risk scores in women with breast cancer (BC).

Methods:
Women ≥18 years, diagnosed with BC between 2005-2012 at a hybrid academic-community practice (Northeast Ohio, US) were included. A Machine Learning (ML) XGBoost algorithm (with survival modelling), developed using a training subset of the cohort (60% train + 20% test), ranked 40 covariates (including demographic, treatment-related and social determinants of health information) for ASCVD prediction using SHAP (SHapley Additive exPlanations) values. The top 10 ML predictors were transformed in a predictive equation using logistic regression models. This equation was tested in the cohort validation subset (20%), and subsequently compared to the ACC/AHA ASCVD risk score via time-dependent receiver operating characteristic curve.

Results:
BC women (n=5,687, Table 1) had a median age of 60 (interquartile range 50-71) years, 17% had advanced stage disease (TNM III-IV), 44.2% received chemotherapy, 60% endocrine therapy, 29.2% radiotherapy, and 73.3% surgery, respectively. Of those, 16.7% had a 10-year ASCVD. The ACC/AHA risk score had an area under the curve (AUC)=0.76 and underestimated ASCVD in 4.9% (mean risk=21.3% [95% CI 19.9-22.6] vs. mean predicted risk=16.4% [95% CI 15.2-17.5]). The equation pooled from the top-10 predictors of the ML algorithm (C-index=0.81 [95%CI 0.80-0.82]) achieved an AUC=0.84.

Conclusion:
Conventional ASCVD risk scores tend to underestimate the risk in women with BC. A cancer-specific model exhibited excellent performance and generated a user-friendly equation for predicting ASCVD risk in this population. Further external validation is needed.
Abstract 14814: Predictors and Outcomes of Extracorporeal Membrane Oxygenation in COVID-19 Patients With Acute Respiratory Distress Syndrome: A Propensity-Matched National Analysis
Authors: Ali Shafaqat , Atti Lalitsiri , Erdem Saliha , Hussain Bilal , Duhan Sanchit , Patel Neel N , Taha Amro , Farooq Faryal , Gonuguntla Karthik , Raheela Fnu , sattar yasar , Alraies M Chadi C
Published: December 2023

Background:
The current data is limited for understanding extracorporeal membrane oxygenation (ECMO) indicators and outcomes in COVID-19 patients with acute respiratory distress syndrome (ARDS).

Methods:
The National In-patient Sample (NIS) database from 2020 was queried to identify COVID-19 patients with ARDS who received endotracheal intubation and further divided into ECMO and Non-ECMO subgroups. Multivariate regression analysis and propensity score matching (PSM) were done to compare outcomes among both cohorts.

Results:
Among 1,666,960 patients (weighted) admitted with COVID-19, 99,785 (5.98%) patients developed acute respiratory distress syndrome (ARDS), and 60,114 (60.2%) were placed on mechanical ventilation. Of these mechanically ventilated COVID-ARDS, 2580 patients (4.3%) were placed on ECMO. Patients with ECMO intervention had higher adjusted odds of blood loss anemia (aOR 9.1, 95% CI: 6.16 - 13.5, PSM 42% vs. 5.4%, P<0.001), major bleeding (aOR 3.79, 95% CI: 2.5 - 5.6, PSM 19.9% vs. 5.9%, P<0.001) and acute liver injury (aOR 1.7, 95% CI: 1.14 - 2.6 PSM 14% vs. 6%, P = 0.009) compared to patients without ECMO intervention. However, in-hospital mortality, acute kidney injury, and cardiac arrest were insignificant. Patients on ECMO had longer hospital stays and higher total costs of hospitalization. Patients placed on venoarterial-ECMO had higher odds of cardiogenic shock (aOR 13.4, CI 3.95 to 46, P<0.001), cardiac arrest (aOR 3.5, CI 1.45 to 8.47, P = 0.005), acute heart failure (aOR 4.18, CI 1.05 to 16.5, P = 0.042) and lower odds of major bleeding (aOR 0.26, CI 0.07 to 0.92) than venovenous-ECMO.

Conclusion:
Mechanically intubated COVID-19 ARDS patients placed on ECMO had no significant difference in mortality. Despite being younger, they had higher rates of in-patient blood loss anemia, major bleeding, and acute liver injury. Resources utilization was significantly higher for the ECMO subgroup. ECMO.
Abstract 14820: Is Mitral Annular Disjunction Associated With Atrial Fibrillation?
Authors: Cesmat Andrew P , Chaudry Abdul M , Gupta Suhani , Weickert Thelsa T , Simpson Ross J , Syed Faisal F
Published: December 2023

Introduction:
Mitral annular disjunction has been associated with increased risk of ventricular arrhythmias. However, its association with atrial fibrillation (AF) in mitral valve prolapse (MVP) is unknown.

Hypothesis:
Mitral annular disjunction (MAD) is associated with atrial fibrillation in patients with MVP.

Methods:
We studied all patients aged 18 - 90 years with MVP on echocardiography between 2016-19 at our institution. Echocardiograms were reviewed for ventricular size and function and mitral valve pathology. Comorbidities, including atrial fibrillation, were identified on chart review. Multivariate logistic regression was used to assess the association of mitral morphologic factors and clinical characteristics with AF in MVP.

Results:
AF was present in 135 (21.2%) of a total 637 MVP patients. AF was present in 5.3% (11/209) under age 60 years, 19.8% (50/253) age 60-75 years, and 43.3% (74/175) over age 75 years. MAD was present in 15.6% (21/135) with AF and 14.7% (74/502) without AF (p=0.79). On multivariate analysis, atrial fibrillation was associated with increased age (OR [95% CI], 1.93 [1.59-2.36] per 10 years, p<0.0001) and heart failure (OR 2.70 [1.62-4.51], p=0.0001), although not moderate or severe mitral regurgitation (OR 1.20 [0.75-1.92], p=0.45).

Conclusion:
Atrial fibrillation is highly prevalent in mitral valve prolapse and independently associated with older age and presence of heart failure. Mitral annular disjunction is not a risk factor for atrial fibrillation in mitral valve prolapse.
Abstract 14830: Digital Central Monitoring Units Reduce Telemetry Alert Burden and Improve Clinician Alert Response Metrics
Authors: Melnychuk Veniamin , Shah Vishrut , Blumingold Richard , Aneja Pallavi , Kelly Jason , Beard John
Published: December 2023

Introduction:
Cardiac electrocardiographic telemetry is guided by AHA Practice Standards and is associated with improved patient outcomes. Cardiac telemetry digital central monitoring units (dCMU) optimize telemetry performance by facilitating alert dispatches and providing processes for quality improvement.

Hypothesis:
Implementation of dCMU would result in a reduced number of alerts transmitted to bedside staff and improved alert management.

Methods:
From May 2022 to March 2023, alerts were collected and analyzed at 6 hospitals transitioned from standard telemetry practice to dCMU. Standard practice includes monitor technicians reviewing alerts and waveforms, ranking alerts and manually contacting clinicians. The dCMU platform organizes and ranks clinical alerts after which a CMU tech dispatches alerts to a mobile app. The bedside clinician receives the alert, patient data, and real time waveform for contextual analysis. The alert is marked “handled” when the provider accepts the message. If the message is not accepted, the alert enters an escalation pathway. The dCMU platform also contains performance analyzing software which guides process improvement.

Results:
Alert counts and characteristics were collected and analyzed during an 11-month period. Comparing a 30-day baseline period to the last 30-day post-implementation period, dispatched alerts to clinician devices decreased 35.5% - from 5,032 to 3,246 alerts per day and the rate of notifications handled by providers increased 88% - from 42% to 78.8% of all dispatched alerts (Figure 1). The total time that patients were in alert state decreased 32.4% - from 31,930 to 21,576 minutes per day.

Conclusions:
The introduction of dCMU structured and streamlined the telemetry dispatch process leading to reduced alert burden and improved bedside clinician alert handling. Further studies are necessary to determine the effects of dCMU dispatch control on patient outcomes compared to standard telemetry practice.
Abstract 14836: Left Ventricular Extracellular Volume on Computed Tomography is Useful for Predicting Reverse Remodeling After Catheter Ablation for Atrial Fibrillation
Authors: Makiko Kinoshita , Takaoka Hiroyuki , Ota Joji , Aoki Shuhei , Suzuki Katsuya , Yashima Satomi , Sasaki Haruka , Eguchi Noriko , Kanaeda Tomonori , Kondo Yusuke , Kobayashi Yoshio
Published: December 2023

Introduction:
In the CAMERA-MRI study, restoring sinus rhythm with catheter ablation (CA) for atrial fibrillation (AF) significantly improved left ventricular (LV) ejection fraction (EF), particularly in the absence of LV myocardial fibrosis, determined by magnetic resonance imaging (MRI). LV extracellular volume fraction (ECV) on MRI correlates with myocardial fibrosis. Recently analysis of LVECV on computed tomography (CT) has been feasible and LVECV on CT and MRI correlate well. Little is known about what predicts achieving LV reverse remodeling (LVRR) after CA.

Hypothesis:
LVECV on pre-ablation planning CT could predict LVRR after CA in patients with AF and reduced LVEF.

Methods:
One thousand three hundred twenty patients underwent CA for AF in our institutions from Apr 2014 to Aug 2022. Of these, 50 patients (4%) with LVEF under 50% on transthoracic echocardiography (TTE) were included. All patients underwent cardiac CT using 320-detector or 256-detector row CT before the CA. LVECV was measured by CT using non-contrast and late-phase cardiac images (Figure A). We defined LVRR as an LV end-systolic volume decrease of 15% or more, an increase in LVEF to 50% or more, or an absolute LVEF increase of 15% or more. We evaluated the utility of LVECV for the prediction of LVRR after CA.

Results:
LVRR was achieved in 31 patients (62%) after CA, and LVECV was significantly lower in them than in the others (31.3 ± 3.3% vs. 35.9 ± 6.6%, P < 0.01) (Figure B). On receiver operating characteristic curve analysis, the best cut-off of LVECV for the prediction of LVRR was 34.8%, and the sensitivity and specificity of LVECV for the prediction of RR were 90 and 68% (the area under the curve was 0.72, Figure C). On multivariate logistic regression analysis, LVECV less than or equal to 34.8% was the only significant predictor of LVRR.

Conclusion:
LVECV on CT is useful for predicting LVRR in patients with AF after CA.