bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12118: Social Disadvantage, Coronary Artery Calcium, and Their Interplay, in the Prediction of Atherosclerotic Cardiovascular Disease Events: The Multi-Ethnic Study of Atherosclerosis
Authors: Acquah Isaac , Cainzos Achirica Miguel , Taha Mohamad , Al-Kindi Sadeer , Khan Safi U , Sharma Garima , Blaha Michael J , Budoff Matthew , Nasir Khurram
Published: June 2023

Introduction:
Social determinants of health (SDOH) are key for the identification of populations at increased risk of developing cardiovascular risk factors (RFs) and ASCVD. In contrast, whether at the individual level SDOH improve current ASCVD risk prediction paradigms beyond traditional RFs and CAC, is unknown. Also, while CAC predicts outcomes across a wide range of risk profiles, its performance across groups with increasing levels of social vulnerability has not been evaluated.

Methods:
MESA is a prospective study of US adults free of clinical ASCVD at baseline. We developed an SDOH index inclusive of 14 determinants from 5 domains. The index ranged 0-1 and was divided into quartiles, with higher ones representing worse SDOH. Cox regression was used to evaluate the adjusted associations between CAC, SDOH, their interplay, and ASCVD events; and C-statistics were used to assess improvement in risk discrimination for prediction of all/hard events with CAC, SDOH, and both.

Results:
We included 6,479 MESA participants (50% with CAC=0, 24% CAC>100). The incidence of hard ASCVD events was higher for increasing CAC scores across all SDOH quartiles (
Figure Panel A
). The lowest incidence was noted in those with CAC=0 and favorable SDOH (2/1000 person-ys) and highest in those with CAC>100 and most unfavorable SDOH (20.6/1000 person-ys). CAC improved the discriminatory ability of prediction models, while improvements with SDOH were smaller and were none on top of CAC (
Panel B
). Results were consistent in analyses that evaluated education and income as SDOH exposures.

Conclusion:
CAC stratifies ASCVD risk across the spectrum of social vulnerability and can guide personalized risk management also among most socially vulnerable populations. In contrast, SDOH fail to improve risk prediction beyond traditional RFs and CAC. Our results provide further support to current ASCVD risk assessment paradigms in the US, and suggest that SDOH have a limited role in this specific setting.
Abstract 12142: Cardiovascular Associations of Chimeric Antigen Receptor T-cell Therapy: A Retrospective Cohort Study From National Inpatient Sample 2016-2019
Authors: Baral Nischit , Santos Volgman Annabelle S , Kunadi Arvind , Abdelazeem Basel , Saleh Hassan , Kambalapalli Soumya , Bashyal Krishna P , Seri Amith Reddy , Paul Timir K , Ojha Niranjan , parajuli prem R , Mitchell Joshua D
Published: June 2023

Introduction:
After FDA approval in 2017, chimeric antigen receptor (CAR) T-cell therapy gained high popularity in various hematological malignancies.

Hypothesis:
There are no sex-based differences in in-hospital mortality and length of stay after CAR T-cell therapy.
Methods and
Results:
From 2018 to 2019, using national inpatient sample, among a total of 14,189,303 hospitalizations (unweighted sample) 704 (0.01%) CAR T-cell therapy were performed, 306 in 2018 and 408 in 2019. Among the CAR T-cell therapy performed, 58.4% (n = 417) were males, 2.9% (n=21) had pulmonary edema, 0.6% (n=6) had acute decompensated heart failure, 3.08% (n=22) had supraventricular tachycardia, 3.36% (n=24) had ventricular tachycardia, 1.94% (n=14) had pericardial effusion (including chronic pericarditis or tamponade), 0.14% (n=1) had acute pericarditis, 0.14% (n=1) had non ST-segment elevation myocardial infarction, 3.64% (n=26) required pressors, 8.68% (n=64) had atrial fibrillation, 3.64% (n=26) had disseminated intravascular coagulation, 4.76% (n=34) required mechanical ventilation. 3.92% (n=28) died in the hospital and mean length of stay (LOS) was 20.5 days. The mean age for CAR T-cell therapy was 54 ± 18 years. Among CAR T cell therapy population, compared to males, females were similar in age (mean age: 54.6 vs. 54 years; p=0.606), had lower incidence of atrial fibrillation (4.38% vs 11.75%, p<0.001) but similar in-hospital mortality (3% vs 4.6%, p=0.334) and similar LOS (21 days vs 20 days, p=0.740).

Conclusions:
CAR T cell therapy is associated with few cardiovascular conditions. We did not find sex-based differences in in-hospital mortality or LOS in CAR T cell therapy.
Abstract 12155: Trends in Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic and Nonischemic Cardiomyopathy: A National Inpatient Sample Trend in the Years 2016-2019
Authors: Ferraro Bruce , Thwe Ei Ei , Shah Kashyap , Modi Vivek , Stevens Steven , Shirani Jamshid
Published: June 2023

Introduction:
  Catheter ablation of ventricular tachycardia (CAVT) has emerged as a viable option in structural heart disease. Recent studies report differences in outcomes of CATV in ischemic (ICM) and non-ischemic (NICM) cardiomyopathy. We aimed to examine temporal trends and in-hospital outcomes of CATV in ICM and NICM.

Methods:
National Inpatient Sample 2016-2019 was queried using ICD-10 codes to identify adults with ICM or NICM who underwent CAVT. Temporal trends were assessed using logistic regression.

Results:
193895 CAVT were performed between 2016 and 2019. CAVT increased in numbers for both ICM [16415 in 2016 to 23030 in 2019 (P<0.001)] and NICM [22915 in 2016 to 31355 in 2019 (P<0.001)] during this period. Overall, rate of most common in-hospital complications increased during study period (7.4% in 2016 to 9.2% in 2019, p<0.0001) particularly of cardiogenic shock (3% in 2016 to 4.2% in 2019, p<0.001) and pericardial effusion (2.9% in 2016 and 3.7% in 2019, p<0.001). In concordance with higher rates of complications over time, there was also an increase in the rate of comorbid conditions as indicated by the Charlson’s Comorbidity Index Score >3 (35% in 2016 and 40% in 2019, p<.0001). Differences existed in the rate of most common in-hospital complications between ICM and NICM patients including cardiogenic shock (5%-vs-2.6%), pericarditis (1.3%-vs-2.1%), pericardial effusion 2.6%-vs-3.7%), and cardiac tamponade 1%-vs-1.5%) [all p<0.001). In-patient mortality and length of stay were higher in those with ICM (1.6%-vs-0.8%; and 6.3-vs-4.9 days; both p<0.001).

Conclusions:
The number of VT ablations for structural heart disease has increased in recent years. These promising procedures are performed with reasonable complication rates in progressively more complex settings. Differences exist in rates of complications between patients with ICM and NICM including in-hospital mortality.
Abstract 12163: Liver Disease in Right Heart Failure: Not Just Fontan Associated
Authors: Christmyer Zane J , Van Heidi , Tow Clara , Ovchinsky Nadia , Hsu Daphne T
Published: June 2023

Introduction:
Hepatic fibrosis, cirrhosis, and hepatocellular carcinoma caused by the Fontan circulation, known as Fontan Associated Liver Disease (FALD), are due to low cardiac output and high venous pressure within the Fontan circuit.

Hypothesis:
We hypothesized that patients with congenital heart disease causing right heart dysfunction would have liver findings similar to FALD.

Methods:
We identified patients with the Fontan circulation or congenital heart disease associated with moderately depressed or dilated RV on echo or MRI, and/or increased right atrial pressure on cardiac cath. We defined hepatic congestion as increased kPA on Fibroscan, liver or IVC abnormalities on US, increased kPA or liver abnormalities on MRI elastography, and/or sinusoidal congestion on liver biopsy. The incidence of hepatic congestion was compared by chi squared analysis.

Results:
A total of 33 patients were identified for this study, 23 Fontan and 10 non-Fontan. Hepatic congestion was found in 25 patients (76%). Hepatic congestion was most often diagnosed by US in both Fontan (82.6%) and non-Fontan patients (40%). The most common findings on liver biopsy, including one non-Fontan Ebstein, were sinusoidal dilation, portal fibrosis, and perisinusoidal fibrosis. The incidence of hepatic congestion in Fontan was no different from non-Fontan however power was limited.

Conclusions:
Hepatic congestion was found in 83% of Fontan and 60% of non-Fontan patients. Fontan and non-Fontan patients alike are at risk for hepatic congestion and there is need for further evaluation to understand the clinical relevance of hepatic congestion caused right heart dysfunction.
Abstract 12164: Gendered Social Determinants of Health and Risk of Major Adverse Outcomes in Atrial Fibrillation: An Analysis From the ESC-EHRA Eurobservational Research Programme in Atrial Fibrillation General Long-Term Registry
Authors: Houle Jonathan , Proietti Marco , Raparelli Valeria , Azizi Zahra , Atzema Clare , Norris Colleen M , Abrahamowicz Michal , Lip Gregory , Boriani Giuseppe , Pilote Louise
Published: June 2023

Introduction:
Atrial fibrillation (AF) is associated with a high risk of adverse outcomes. Social determinants of health (SDOH) are gendered (unevenly distributed between females and males) and associated with outcomes in cardiovascular diseases. Little is known about their impact in AF. We evaluated the association between gendered SDOH and adverse outcomes in AF patients.

Methods:
Data came from the ESC-EHRA EORP-AF General Long-Term Registry, a European AF prospective registry. Gendered SDOH included: education, living alone vs not, smoking, alcohol use, gender inequality index (GII), physical activity and quality of life measures. Study outcome was a composite of major adverse cardiovascular events and all-cause death. SDOH main effect was tested in multivariate logistic regressions and for a sex/GII interaction.

Results:
We studied 11,096 patients (mean (SD) age 69.2 (11.4) years; 40.7% females, median [IQR] CHA
2
DS
2
-VASc score 3 [2-4]). Most had secondary education, did not live alone, did not smoke or use alcohol, were physically inactive, had moderate quality of life, and lived in countries with gender equity. Multivariate analyses showed that gendered SDOH together with traditional risk factors were associated with the outcome (Figure 1). Higher education level and quality of life were associated with lower risk of adverse outcomes. Conversely, living alone and higher GII (larger gender inequity) were associated with worse outcomes. Females were found at lower risk, however this protective effect was reversed in countries with higher GII (sex-GII p-
interaction
0.048).

Conclusions:
Gendered SDOH are associated with adverse outcomes in AF. Notably, gender inequity confers poorer outcomes in females with AF.
Abstract 12167: High BNP and NT-proBNP Level as a Poor Prognostic Indicator an Patients With Hypertrophic Cardiomyopathy: A Systematic Review and Meta-analysis
Authors: Singh Sandeep , Gudiwada Mohan Chandra Vinay Bharadwaj , Gaddam Vinuthna , Mozaffari Mohammad Ali , AHMADZADEH Nazanin , Akbariromani Hanieh , Perera Ayodya , Naseem Hamna , Lankala Chetan Reddy , Jain Akhil , Desai Rupak
Published: June 2023

Background:
Raised BNP/NT-pro BNP has been reported as a poor prognostic indicator in hypertrophic cardiomyopathy (HCM) patients. However, the unavailability of pooled data utilizing BNP/NT-proBNP as a prognostic biomarker led us to perform this systematic review and meta-analysis.

Methods:
Using relevant keywords, PubMed/Medline, Scopus, and EMBASE were systematically reviewed to evaluate studies reporting all-cause mortality or sudden death with BNP/NT-pro BNP through May 2022. Random effects models and I
2
statistics were used for pooled hazard ratios (HR) and heterogeneity assessment using Review Manager (RevMan) [Computer program]. Version 5.4, The Cochrane Collaboration, 2020.

Results:
Our systematic review included sample size of 6691 from 12 studies [Table 1]. Four publications were from China, 2 from Japan and Turkey each and 1 from USA, UK, Italy and France each. Age ranged from 46-55 years with a follow up time from 3-8 years. High NT-proBNP was associated with significantly high risk of all-cause mortality in both unadjusted (HR 1.69, 95%CI: 1.30-2.20, p<0.05, I
2
=90%) and adjusted models (HR 3.73, 95%CI: 1.36-10.21, p<0.05, I
2
=83%), and of sudden death in adjusted (HR 4.78, 95%CI: 1.49-15.34, p<0.05, I
2
=89%). Raised BNP level was associated with adjusted sudden death (HR 5.10, 95%CI: 3.03-8.61, p<0.05)
(Fig. 1).

Conclusions:
This meta-analysis suggested that higher BNP/NT-proBNP level was associated with high risk of combined all-cause mortality and sudden death in patient with hypertrophic cardiomyopathy.
Abstract 12168: Pi3kγ is a Key Modulator of Cardiac Metabolism Rewiring Occurring in Doxorubicin-Treated Mice
Authors: Russo Michele , Priolo Rebecca , Guerra Giulia , Riganti Chiara , Hirsch Emilio , Ghigo Alessandra
Published: June 2023

Introduction:
Doxorubicin (DOX) is a potent chemotherapeutic drug, whose use is hampered by the onset of long-term cardiotoxicity and lack of effective therapeutic approaches. Recently, metabolic perturbations have emerged as an early predictor factor of cardiac dysfunction, but how DOX affects cardiac metabolism is still unknown. We have previously demonstrated that phosphoinositide 3-kinase γ (PI3Kγ) is a major driver of DOX-evoked cardiotoxicity through mitophagy inhibition and accumulation of dysfunctional mitochondria.

Hypothesis:
Here we sought to explore the role of PI3Kγ in modulating cardiac metabolism upon DOX administration.

Methods:
Metabolomic analysis, glycolysis and oxidative phosphorylation were measured in whole hearts from wild-type (WT) and knock-in mice expressing a kinase-inactive PI3Kγ (kinase-dead; KD) treated with DOX (4 mg/kg on day 0, 7 and 14). Similar analyses were performed in WT and KD hearts infected with AAV9-shATG7 to explore the role of autophagy. Moreover, glucose uptake and GLUT-4 expression on the plasma membrane were measured in WT and KD neonatal mouse cardiomyocytes (NMCs) exposed to 1μM DOX.

Results:
Metabolomic analysis revealed an increased level of succinate and malic acid in DOX-treated hearts, suggesting defects in the TCA cycle. In agreement, DOX promotes the accumulation of metabolites normally catabolised in the TCA cycle, such as aminoacids and pyruvate, indicating a severe mitochondria dysfunction. Accordingly, fatty acid oxidation and electron transport chain activity were impaired in DOX-treated hearts at day 3 and exacerbated at day 42 after DOX. At the same time, glycolysis was upregulated. These changes were prevented in KD animals. Interestingly, upon autophagy inhibition, KD mice lost their cardioprotection at the mitochondrial level, but they still failed to upregulate glycolysis. This suggests a new autophagy-independent mechanism through which PI3Kγ regulates glucose utilisation. In agreement with the pharmacological and genetic inhibition of PI3Kγ abrogates glucose uptake in NMCs and normalises the plasma membrane exposure of GLUT-4.

Conclusions:
Overall, these results promote PI3Kγ as a master regulator of metabolic rewiring occurring in DOX-treated cardiomyocytes.
Abstract 12169: Re-Imagining Fontan Support: Novel Cavopulmonary Connection Can Accommodate Mechanical Circulatory Support, Augment Cardiac Output and Balance Hepatic Flow
Authors: Hardikar Priyanka , Cleveland Vincent , Contento Jacqueline , Mass Paige , Wu Qiyuan , Loke Yue-Hin , Krieger Axel , Sinha Pranava , Olivieri Laura
Published: June 2023

Introduction:
Improved Fontan survivorship requires novel treatments for late complications and inevitable failure. Typical total cavopulmonary connection (TCPC) shapes perform well in the short term yet competitive flows create challenges in providing mechanical circulatory support (MCS) due to two inflows/outflows. A novel, feasible Fontan shape, the Convergent Cavopulmonary Connection (CCPC), converges venous return to create a single inflow and outflow for easy institution of MCS, and maintains favorable hepatic flow distribution (HFD) and power loss. The impact of MCS on CCPC hemodynamic performance is still unknown.

Hypothesis:
In vitro implantation of a single MCS device into patient-specific CCPCs will be feasible and produce augmented cardiac output and acceptable HFD, compared to traditional TCPC.

Methods:
A benchtop mock circulatory flow loop using 60/40 glycerin equipped with inlet/outlet flow meters and outflow optical registers was used to analyze five 3D-printed TCPC and CCPC models derived from cardiac MRI images. Patient-specific flow conditions were applied to each model’s inlets/outlets. HFD was measured using an injection of blue tracer dye in the IVC and the optical concentration at the LPA and RPA outlets was compared. The CCPC models were also retrofitted to accommodate an Impella ventricular assist device (VAD) and PediPump VAD. HFD and cardiac index (CI) (IVC+SVC flow return) were compared with linear regression and paired t-test.

Results:
All CCPC HFD were within optimal range. Addition of either MCS device to the CCPC creates incremental increase of CI (p<0.01) and significant improvement in HFD balance vs baseline TCPC (p=0.03), reflecting the dominance of the MCS mixing over anatomic influence on HFD.

Conclusions:
Patient-specific CCPC Fontan designs can successfully accommodate MCS implantation. Addition of MCS in benchtop testing shows improved CI and HFD, mitigating anatomic impact on HFD.
Abstract 12174: Inflammation-Dependent Hydroxyeicosatetraenoic Acids Dysregulate Macrophage Resolution Function
Authors: Meriwether David , Sauk Jenny S , Yin Xiaoxiao , Noori Shoreh , Fogelman Alan M , Martin Martin G , Reddy Srinivasa T
Published: June 2023

Introduction and Hypothesis:
Macrophage efferocytosis is a critical step in the resolution of inflammation. Dysregulated macrophage efferocytosis has been implicated in the pathogenesis of chronic inflammatory disorders including atherosclerosis and IBD. Nonetheless, the nature of possible dysregulating mechanisms remains incompletely understood. We reported that non-enzymatic lipid peroxidation and the mucosal levels of monohydroxylated PUFAs including 12- and 15-hydroxyeicosatetraenoic acid (HETE) correlated with disease in murine models of IBD. HETEs can form enzymatically and non-enzymatically and can signal through the leukotriene (LT) receptor BLT2. LTB4-BLT1/2 signaling can suppress macrophage efferocytosis capacity. We hypothesized that non-enzymatically derived mucosal HETEs correlate with disease in a murine Crohn’s disease (CD) model and in IBD patient biopsies; and that HETEs suppress murine and human macrophage efferocytosis capacity.

Methods:
We exploited the stereospecificity of enzymatic HETE formation to determine by chiral-LC-MS/MS the levels of non-enzymatically derived HETEs in intestine from a murine myeloid
Cox2
knock-out model of Crohn’s disease (CD) and in human IBD patient biopsies. We assessed the effect of racemic HETEs on the efferocytosis capacity of murine BMDMs and human THP1 macrophages for apoptotic MPRO neutrophils. We performed proteomics using accurate mass LC-MS/MS followed by GO enrichment analysis.

Results:
Non-enzymatically derived mucosal 5-, 12-, and 15HETE were elevated with disease: a) by 3-4 fold in the murine CD model (p<0.01 to p<0.0001); and b) by 2-3 fold in ileal and colonic biopsies from areas of active inflammation in CD and ulcerative colitis patients compared to remission controls (p<0.05). Racemic HETEs suppressed efferocytosis of apoptotic neutrophils by murine (12- and 15-HETE: p<0.0001) and human (12-HETE: p<0.0001) macrophages. Racemic 12-HETE altered the proteome of efferocytic BMDM by inducing 200 proteins while silencing 200 more (<1% FDR), and by suppressing pathways associated with efferocytosis.

Conclusion:
Inflammation-dependent HETEs may suppress macrophage efferocytosis in chronic inflammatory disorders including IBD and atherosclerosis.
Abstract 12180: Post-Implant Beta Blocker Use and Late Right Heart Failure After LVAD Implantation: An STS-INTERMACS Analysis
Authors: Hyland Patrick M , kennedy kevin , Sriwattanakomen Roy , Sabe Marwa , Ho Jennifer E , Quintero Pablo A , fleming lisa , Motiwala Shweta R , Kiernan Michael S , Garan Arthur Reshad , Grandin E. Wilson
Published: June 2023

Introduction:
Late right heart failure (LRHF) after left ventricular assist device (LVAD) implant is associated with increased morbidity and mortality. Whether post-implant beta-blocker (BB) use can mitigate the incidence of LRHF is unknown.

Methods:
We queried the STS-INTERMACS registry from 2008-2018 for adults receiving a primary, continuous-flow LVAD and surviving to 3 months without ongoing RHF, defined as presence of a right ventricular assist device (RVAD) or inotropic support. We excluded patients with atypical LVAD cannulation, bridge-to-recovery strategy, ongoing renal replacement therapy, or missing BB status at 3 months. At 3 months post-implant, patients receiving BB were propensity-matched 1:1 to those not receiving BB using a nearest-neighbor method without replacement. The primary outcome was a composite of all-cause mortality or LRHF, including the need for RVAD, inotropic support, or hospitalization for RHF or fluid overload, and was compared between groups with the Kaplan-Meier method and log-rank testing.

Results:
Among 14,317 patients meeting inclusion criteria, 4,880 patients receiving BB at 3 months were matched with 4,880 not receiving BB. Baseline covariates were well-balanced (Figure, panel A) and 11.2% of patients experienced early RHF. Over 3-years of follow up, patients receiving BB had a lower incidence of the primary outcome hazard ratio (HR) 0.91 (95% CI: 0.85-0.97), p=0.007 (Figure, panel B). This difference was driven primarily by lower rates of hospitalization for RHF or fluid overload (HR 0.83, 95% CI: 0.72-0.95, p=0.008) and all-cause mortality (HR 0.91, 95% CI: 0.82-1.02, p=0.11) while rates of late RVAD or inotropic support were similar.

Conclusions:
In this retrospective, propensity-matched analysis, the use of beta blockers after LVAD implant was associated with a modest reduction in the composite of all-cause mortality and LRHF. These data suggest BB may mitigate LRHF and should be confirmed with prospective studies.
Abstract 12201: Assessing Glycated Hemoglobin (a1c) Thresholds for Development of Cardiovascular Disease by Racial-Ethnic Groups; Insights From a Large Integrated Healthcare System
Authors: Liu Yu Hsin , Merchant Maqdooda , Low Christopher , Vu joseph , Pursnani Seema
Published: June 2023

Introduction:
Diabetes mellitus (DM) is the strongest risk factor for incident myocardial infarction (MI). Glycated hemoglobin (A1c) is used for diagnosing DM, but racial/ethnic specific A1c diagnostic thresholds do not exist. This study aims to determine whether A1c thresholds for predicting major adverse cardiac events (MACE) differ among racial-ethnic groups in a large, diverse integrated healthcare system.

Methods:
This is a retrospective cohort study of Kaiser Permanente Northern California members age 30 to 75 without cardiovascular disease for whom A1c during 2014, race/ethnicity data, and 5-year follow-up post A1c were available. Multivariable logistic regression was used to evaluate the odds of MACE (MI, stroke, cardiovascular death) after adjusting for demographic and clinical covariates including age, sex, race, A1c, BMI, smoking, DM meds. Univariate logistic regression with Youden’s index was used to determine A1c thresholds for MACE prediction stratified by race/ ethnicity. Receiver operating characteristic curves were plotted for each equation and a Youden’s index was calculated to determine the race-ethnic specific threshold for prediction of MACE.

Results:
A1c was associated with an increased odds of MACE (aOR 1.024, 95%CI: 1.022, 1.025). Compared to Whites, South Asian ethnicity was associated with increased odds of MACE (aOR 1.641, 95%CI: 1.456, 1.843). Hispanic (aOR 0.748, 95%CI: 0.702, 0.796) and East Asian ethnicities (aOR 0.804, 95% CI: 0.739, 0.874) were associated with lower odds of MACE. A Youden’s index range of A1c values between 6.0 to 7.3% predicted MACE, with the lowest values seen in Whites (6.0%) and South Asians (6.1%). A1c thresholds for Filipinos, East Asians, Blacks, and Hispanics were 7.3, 6.6, 6.5 and 6.5%, respectively.

Conclusions:
Our study shows South Asians have a higher odds of MACE compared to Whites. A1c values in a pre-diabetic range predicted MACE in Whites and South Asians, whereas thresholds for MACE prediction were in a diabetic range for other groups. Further studies will help identify whether these trends can be replicated in other geographic areas and influence risk prediction tools.
Abstract 12215: A Case of Post-Vaccine Myocarditis Mimicking Long Covid
Authors: Hirsch Eric , Slipczuk Leandro , Travin Mark , Moadel Renee , Jorde Ulrich P , VUKELIC Sasha
Published: June 2023

Myocarditis is a rare complication following mRNA-based COVID vaccinations. While the risk appears to be greatest in adolescent males, increased rates of myocarditis following COVID vaccination have been documented in both sexes and across multiple age groups.In this case, a 59-year-old woman with history of mild COVID infection developed unexplained fatigue, diminished exercise capacity, and intermittent chest discomfort several days after receiving her first dose of the Pfizer-BioNTech COVID-19 vaccine. She was seen in the emergency department at the onset of symptoms and found to have a dynamic troponin elevation peaking at 177 ng/L. A comprehensive workup including regadenoson stress testing, CT scan of the chest with contrast, and ambulatory cardiac monitoring failed to demonstrate an etiology. She subsequently received a second dose of the COVID-19 vaccine which resulted in worsening cardiopulmonary symptoms that persisted over the next several months. Her symptoms were initially attributed to long COVID, and she was provided supportive care and an SSRI for anxiety. After reevaluation in the Cardiology clinic, the patient underwent cardiac MRI revealing edema in the basal lateral wall and late gadolinium enhancement in a subepicardial distribution, suggestive of myocardial inflammation. She was treated with prednisone 50 mg daily and colchicine 0.6 mg twice daily resulting in resolution of chest pain. A repeat MRI performed two weeks later showed complete resolution of myocardial edema with residual subepicardial LGE in the basal lateral wall consistent with prior myocarditis.This case demonstrates the pitfalls of relying on a diagnosis of ‘long COVID’ to explain concerning cardiac symptoms of uncertain etiology and highlights post-vaccine myocarditis as an important differential in the COVID-19 era. At this time, it is unclear how many patients experience persistent cardiopulmonary symptoms following COVID vaccination and whether a subset of these patients have undiagnosed myocarditis. It is important for clinicians to be alert to the possibility of post-vaccine myocarditis in patients presenting with persistent symptoms following vaccination, regardless of demographic profile.
Abstract 12218: Nationwide Trends in Subsequent Myocardial Infarction Hospitalizations and Mortality in Elderly Patients With Prior Myocardial Infarction and Associated Racial/Socioeconomic Disparities: A National Inpatient Sample Analysis
Authors: Jain Akhil , Edusa Samuel , Sharma Aditya , Naseem Rabia , Kang Gurmannat SIngh , Singh Ibadat Anmol , Desai Aakash , Patel Yash , Reddy Shilpa , Reyaz Nafisa , STANIKZAI SAMIR , Desai Rupak
Published: June 2023

Background:
There is a scarcity of large-scale data on race, sex, and economic status-based disparities in trends of subsequent/recurrent myocardial infarction (MI) in elderly individuals who have had a previous MI.

Methods:
National Inpatient Sample databases (2016-2019, ICD10 codes) were queried to identify elderly (≥65 years) patients with prior MI and divided into having and not having subsequent MI admissions. Primary outcomes were nationwide trends in subsequent MI admissions and all-cause in-hospital mortality in these patients with racial, sex, and economic status disparities.

Results:
A total of 421,960 recurrent MI admissions were identified [61.1% male, 38.9% female, 80.7% white and median age 76yrs (p<0.001)]. Between 2016 and 2019, both males and females experienced an increase in recurrent MI from 9.1 to 10.6% and 8.1 to 9.8%, respectively, but a reassuring decrease in in-hospital mortality from 7.75 to 6.4% and 7.8 to 6.6% (P
trends
<0.001). All race groups demonstrated a rise in recurrent MI, with blacks experiencing the largest increase from 9.2 to 11.7%(P
trend
<0.001). In-hospital mortality for recurrent MI declined in all races except blacks and Native Americans (P
trends
>0.05), with Asian/Pacific Islanders experiencing the highest decline from 13 to 7.4%(P
trends
<0.001). All income quartile groups had an increase in recurrent MI with a more prominent increase in the lowermost income quartile cohort (P
trends
<0.001). There was an overall trend of decreasing in-hospital mortality except for the lowermost income quartile which did not show improving trends in mortality (P
trend
=0.079).

Conclusions:
Elderly patients with a history of MI had an upward tendency for recurrent MI hospitalizations but a downward trend for all-cause in-hospital mortality with prevailing racial and socioeconomic disparities. Blacks and lower income quartile patients with CVD risk may need focused post-MI care to curtail subsequent MI and mortality risk.
Abstract 12222: The Significance of Concealed Fasciculo-Ventricular Connections in His Bundle Pacing
Authors: Mahmud Rehan , Sternick Eduardo , Sanchez Quintana Damian , Macias Yolanda , Jamal Shakeel , Bailey Beth , De Almeida Marcos C , Anderson Robert H
Published: June 2023

Introduction:
It is almost 100 years ago since Mahaim described so-called paraspecific connections between the ventricular conduction axis and the crest of the muscular ventricular septum, believing such pathways to be ubiquitous.

Hypothesis:
These pathways have yet to be considered as potential pathways for septal activation during His bundle pacing

Methods:
So as to explore the hypothesis that specialized septal pathways provide the substrate for septal activation during His bundle pacing, we compared the findings from 22 serially sectioned histological datasets and 96 different individuals undergoing pacing of the His bundle.

Results:
We found extensive histologically specialized pathways connecting the branching bundle with the crest of the muscular ventricular septum in almost four-fifths of the histological datasets. A delta wave was observed in nine-tenths of the individuals undergoing His bundle pacing. Capture of the delta wave varied according to voltage, a finding which correlated with the distance of the septal pathways from the site of penetration of the ventricular conduction axis. Ventricular activation times remained normal in the presence of the delta wave. A significant decrease in ventricular activation times was observed in individuals with disease of the ventricular conduction system.

Conclusions:
Analysis of the effect of delta wave on ventricular activation times permits us to conclude that His bundle pacing captures the fasciculo-ventricular connections initially described by Mahaim as being paraspecific and ubiquitous.
Abstract 12237: Transcatheter Aortic Valve Replacement in Very Low Gradient Aortic Stenosis
Authors: Raikar Connor , Crawford Erin , Baldridge Abigail , Meng Zhiying , Narang Akhil , davidson charles , Malaisrie S C
Published: June 2023

Introduction:
Transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement is recommended for symptomatic patients with high-gradient aortic stenosis (HGAS) and certain patients with low-flow, low-gradient aortic stenosis (LGAS). While TAVI may be beneficial in LGAS (mean pressure gradient (MPG) <40 mmHg), the outcomes of TAVI in very low-gradient AS (VLGAS) patients (<25 mmHg) is under-reported.

Methods:
This retrospective cohort study analyzed 1269 patients who underwent TAVI at a multi-disciplinary, tertiary-care center. Patients with severe aortic stenosis were divided into VLGAS (≤25mmHg), LGAS (>25 mmHg up to 40 mmHg) and HGAS groups (≥40 mmHg), using MPG derived from transthoracic echocardiography. Symptom improvement was measured by New York Heart Association (NYHA) functional classification at baseline, 30-days, and 1-year. Mortality and rehospitalization were secondary endpoints. Between group differences were evaluated with chi-squared tests.

Results:
Patients with VLGAS had improvement in NYHA functional class after TAVI that was similar to those with LGAS and HGAS (figure). While symptom improvement was similar between groups at 30 days (86% in VLGAS, 84% in LGAS and 85% in HGAS, p=0.46), VLGAS was associated with inferior symptom improvement at 1 year (76%, 87%, and 89%, respectively, p<0.01). One-year rehospitalization rates were higher in patients with VLGAS than in patients with LGAS or HGAS (28%, 21%, and 17%, respectively, p =0.014). Mortality at 1-year did not differ between groups (p=0.65).

Conclusion:
TAVI improves symptoms in most LGAS patients, including those with VLGAS. More VLGAS patients with either no change or worsened symptoms after TAVI may be correlated to increased rehospitalization.
Abstract 12284: Utilizing Automated Machine Learning for Rheumatic Heart Disease Detection in Doppler Echocardiography
Authors: Brown Kelsey , Roshanitabrizi Pooneh , Beaton Andrea Z , Okello Emmy , Rwebembera Joselyn , Linguraru Marius , Sable Craig A
Published: June 2023

Introduction:
Rheumatic heart disease (RHD) is the number one cause globally of morbidity and mortality from heart disease in children and young adults. The mitral regurgitation (MR) jet length on color Doppler echocardiography is an important index for diagnosis, but its measurement and interpretation vary.

Objective:
Develop an automatic machine learning approach to identify and measure the MR jet length on color Doppler for RHD detection.

Methods:
We used 316 echocardiograms from 95 children (mean age 12±2 years; range 5 to 17 years) with DICOM color Doppler images of the mitral valve taken from parasternal long axis (PLAX) and apical 4 chamber (AP4) views. All echocardiograms were independently reviewed by an adjudication panel consisting of four expert pediatric cardiologists to determine maximum MR jet length and diagnosis (RHD or normal). Among 95 cases, 29 were normal and 66 had RHD. Our automated method included. (1) Selection of frames during ventricular systole using a convolutional neural network architecture. (2) Localization of left atrium using convolutional neural networks with LinkNet structure. (3) Measurement of MR jet length by image color analysis. (4) Detection of RHD by applying a generalized regression model based on the maximum MR jet length measured and maximizing the balanced accuracy using cross validation.

Results:
Machine learning selected the correct systolic frame with an average accuracy of 0.95 (sensitivity 97%/specificity 93%) and 0.94 (sensitivity 94%/specificity 94%) for the AP4 and PLAX view, respectively. It localized the atrium with an average Dice coefficient of 0.89 and 0.9 for the AP4 and PLAX view, respectively. We estimated the MR jet length with an average absolute error of 0.33±0.4 cm (p-value = 0.15 compared to manual measurements). Our deep learning approach performed similar to or better than previously published manual methods for categorization of RHD positive vs negative. The accuracy of RHD detection was 0.84 (sensitivity 86%/specificity 79%).

Conclusions:
Our automatic method has the potential to reliably detect RHD as accurately as expert cardiologists. This innovative approach holds promise to scale echocardiography screening for RHD and expand prophylaxis to prevent progression of RHD globally.
Abstract 12310: Comparison of Coronary Artery Calcium Quantification Methods in Statin Users and Non-Users
Authors: Ho Woon Wei , Tan Alvin Chun Sheng , Jiang Yilin , Keng Felix , Tan Swee Yaw , Baskaran Lohendran
Published: June 2023

Background:
Coronary artery calcium (CAC) can be quantified using various methods. The Agatston score (AS) computes the weighted sum of lesions with the maximum plaque attenuation factor. Calcium Volume measures the total volume of CAC, whereas Calcium Density has been shown to provide superior prognostication compared to the AS. Since statin use is associated with change in coronary plaque composition and thus CAC, we evaluated the difference CAC quantification methods among patients with suspected CAD receiving and not receiving statin therapy.

Methods:
Patients with suspected CAD and underwent cardiac computed tomography were recruited from a tertiary hospital in Singapore. Patient demographics and risk factors were obtained from electronic medical records. AS, Calcium Volume, Number of Lesions and Calcium Density were individually analysed with patient demographics and risk factors using multivariate models. Results were compared between patients on statins and not on statins to assess differences in CAC quantification methods.

Results:
Of the 528 patients, 43.0% were female, 40.9% had hypertension, 14.8% had diabetes, 44.3% had family history of CAD and 23.5% were smokers. While 58.5% of patients had hyperlipidemia, only 48.9% were on statin therapy. The mean age was 53.9±10.9 years, and the mean BMI was 26.1±5.69. Diabetes, hypertension, family history of CAD, and older age was more likely present in statin users (P < 0.05 for all). In multivariate analysis, these variables and higher BMI were significantly associated with statin use in all four models (Table 1). For CAC quantification, Calcium Volume, AS, and Number of Lesions did not differ significantly between statin users and non-users, whereas Calcium Density was higher in statin users (OR = 1.19, CI = (1.02, 1.39), P = 0.025).

Conclusions:
Statin use is associated with higher Calcium Density but is not associated with differences in other CAC quantification methods in patients with suspected CAD.
Abstract 12314: Bivalirudin versus Unfractionated Heparin During Percutaneous Intervention for Chronic Total Occlusion: A Systematic Review and Meta-Analysis
Authors: Burmeister Cameron , Ghazaleh Sami , Patel Neha , Bhuta Sapan , Sajdeya Omar , Pena Clarissa , Safi Mohammad , Alharbi Abdulmajeed Abdullah , Sharma Sadikshya , Yassen Mohammad , Beran Azizullah , Mhanna Mohammed , Eltahawy Ehab
Published: June 2023

Introduction:
Chronic total occlusion (CTO) percutaneous intervention (PCI) is an evolving challenge within interventional cardiology. Anticoagulation during percutaneous intervention remains part of the standard of care for patients undergoing PCI to prevent thrombotic complications peri-procedurally. Unfractionated heparin (UFH) is a commonly used for CTO PCI-related anticoagulation. However, bivalirudin (BV), a synthetic, reversible, direct thrombin inhibitor, has been utilized as an alternative to UFH in CTO patients undergoing PCI. This meta-analysis aims to investigate the efficacy and safety of bivalirudin versus UFH for CTO PCI.

Methods:
We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases through May 2022 for all studies evaluating efficacy and safety of bivalirudin versus UFH in CTO patients undergoing PCI. The primary outcome was mortality. Secondary outcomes were major adverse cardiac events (MACE), major bleeding events, peri-procedure myocardial infarction (MI), in-stent thrombosis, and unplanned revascularization. Pooled risk ratio (RR) and 95% confidence intervals (CIs) were obtained by the Mantel-Haenszel method within a random-effects model. Heterogeneity was assessed by I2 statistic.

Results:
A total of 5 studies containing 1347 patients with CTO undergoing PCI on anticoagulation (631 BV versus 716 UFH) were included. No significant difference existed between BV and UFH regarding mortality [RR: 0.54 (95% CI: 0.19-1.56); P 0.26 , I2 0%]. Major bleeding events were significantly lower in BV compared with UFH [RR: 0.33 (95% CI: 0.19-0.66); P 0.001, I2 0%]. MACE [RR: 0.75 (95% CI: 0.55-1.00); P 0.05, I2 2%], peri-procedure MI [RR: 0.80 (95% CI: 0.56-1.15); P 0.24, I2 0%], in-stent thrombosis [RR: 0.68 (95% CI: 0.19-2.39); P 0.55, I2 17%] and unplanned revascularization [OR: 0.77 (95% CI: 0.29-2.07); P 0.61, I2 0%] were similar between the two groups.

Conclusions:
BV seems to be safer than UFH in preventing major bleeding in anticoagulated patients with CTO undergoing PCI; there is no significant difference between groups in terms of mortality, MACE, peri-procedure MI, in-stent thrombosis, or unplanned revascularization. Future randomized controlled trials are needed.
Abstract 12329: Checkpoint Kinase 1 Protein Therapy Stimulates Endogenous Cardiomyocyte Renewal and Cardiac Repair in a Porcine Model of Myocardial Ischemia/Reperfusion Injury
Authors: wei tianwen , Shan TianKai , Wang Hao , yang tongtong , chen jiawen , Wang Liansheng
Published: June 2023

Objective:
To investigate the impact of recombinant human checkpoint kinase 1 (rhCHK1) on cardiomyocyte renewal and myocardial repair after myocardial ischemia/reperfusion (I/R) injury in swine.

Methods:
Quantitative phosphoproteomics profiling was performed on infarct border zone of neonatal myocardium, and kinase-substrate network analysis using iGPS algorithm revealed CHK1 kinase with enriched substrates and upregulated phosphorylation levels. Swine myocardial ischemia/reperfusion injury was induced by ligating the left anterior descending coronary artery for 60 minutes, and followed by reperfusion. Immediately after reperfusion, rhCHK1 protein (1mg/kg) dissolved in hydrogel or equivalent hydrogel was injected into the infarcted border zone. The therapeutic efficacy of rhCHK1 post I/R injury was evaluated by ECG, echocardiography, MRI, hematological indices and immunofluorescence.

Results:
Intramyocardial injection of rhCHK1-hydrogel efficiently delivered rhCHK1 to the cardiomyocytes surrounding the infarcted area of pig hearts without affecting other organs. A single administration of rhCHK1 protein (1mg/kg) prominently stimulated cardiomyocytes proliferation, reduced cardiac inflammation and improved vascularity 3 days after I/R. At 28-days post rhCHK1-hydrogel therapy, improved cardiac function, reduced infarct size and cardiac scar area, and attenuated ventricular remodeling were evidenced in I/R swine. Mechanistically, rhCHK1 stimulated CMs renewal and cardiac repair by activating mTOR/CTHRC1/P70S6K signaling pathways.

Conclusion:
Our study demonstrates that myocardial injection of rhCHK1 could promote cardiomyocyte proliferation, inhibit local myocardial inflammation and promote angiogenesis to facilitate myocardial repair and cardiac function after I/R injury in adult pigs through activating mTOR/CTHRC1/P70S6K signaling pathways.
Abstract 12349: Can Biomarkers and Risk Scores Be Used to Select Patients With Type 2 Diabetes Mellitus for Testing for Subclinical Left Ventricular Dysfunction
Authors: Halabi Amera , Potter Elizabeth , Yang Hong Hilda , Wright Leah , Sacre Julian W , Shaw Jonathan , Marwick Thomas
Published: June 2023

Background:
Subclinical LV dysfunction (LVD) identifies heart failure (HF) risk in type 2 diabetes mellitus (T2DM).

Hypothesis:
Clinical scores (ARIC HF and WATCH-DM) and NTpBNP can be used as screening tests to identify which people should undergo echo.

Methods:
803 asymptomatic subjects (69 years [IQR 65-73], 36% female) with T2DM were prospectively recruited from three community-based populations. All underwent a comprehensive echo to identify abnormal global longitudinal strain (GLS
>
-16%), diastolic function (E/e’
>
14 or e’<8cm/s), left atrial volume index (LAV>34ml/m
2
) or LV hypertrophy (LV mass index>88g/m
2
(F)>102g/m
2
(M)). ARIC HF risk at 4 years and WATCH-DM scores were calculated from clinical data. NTpBNP was measured using an electro-chemiluminescence assay.

Results:
In the cohort, 126 (17%) had an abnormal GLS, 16 (2%) elevated E/e’, 266 (33%) had impaired e’, 351 (44%) had increased LAV and 113 (14%) had LV hypertrophy. Median NTpBNP level was 50pg/mL [25-101]. Clinical scores corresponded to expected HF risk (ARIC-HF 8% [4-12]; WATCH-DM 10 points [8-12]). NTpBNP was weakly associated with GLS after adjustments for age, body-mass index, and renal function (β=0.004 [95% CI 0.003 to 0.004], p<0.001). Similar trends were observed with ARIC HF (β=0.07 [0.05 to 0.09], p<0.001) and WATCH-DM (β=0.19 [0.13 to 0.25], p<0.001) in univariable analyses. None of the risk assessment tools provided a satisfactory AUC for detection of abnormal GLS, diastolic indices or LV mass (Table) (
p
=0.804). Development of cut-points to optimize sensitivity (to 90%) led to an unacceptably low specificity (Table).

Conclusion:
Although risk assessment based on clinical scores or biomarkers would be desirable to stratify HF risk in people with T2DM, they show a weak relationship with subclinical LV dysfunction.
Abstract 12371: Impact of Guideline-Directed Medical Therapy on 5-year Mortality in Patients With Newly Diagnosed Peripheral Artery Disease
Authors: Lee Jung-Hee , Jeon Ho Sung , Kim Young In , Lee Jun-Won , Youn Young Jin , Ahn Sung Gyun G
Published: June 2023

Introduction:
Current guidelines recommend that patients with peripheral artery disease (PAD) should be treated with antithrombotic agents, renin-angiotensin-system (RAS) blocker, and statin. However, the clinical impact of guideline-directed medical therapy (GDMT) on long-term mortality for newly diagnosed PAD is not clear.

Objective:
To investigate the prevalence of GDMT and evaluate 5-year mortality according to GDMT after PAD diagnosis.

Methods:
This retrospective cohort study using a nationwide health insurance claim data in Korea included patients with newly diagnosed with PAD from 2002 to 2015. GDMT was defined as the use of all drugs, including antithrombotic agents, RAS blocker, and statin, within 3 months after PAD diagnosis. The primary endpoint was all-cause mortality.

Results:
We finally investigate 19,561 patients with newly diagnosed PAD. Among the study population, 4,378 patients (22.4%) were categorized as GDMT and 15,183 patients (77.6%) were non-GDMT. During the 5-year follow-up duration, GDMT showed a lower incidence of all-cause mortality compared to non-GDMT (2.8% vs. 4.8%; hazard ratio [HR], 0.514; 95% confidence interval [CI], 0.424-0.623; p<0.011). Even after propensity matched population, GDMT showed lower mortality rate than non-GDMT (HR 0.283; 95% CI, 0.217-0.370; p<0.001). Among non-GDMT regimens, patients without both RAS blockers and statins had a higher 5-year mortality compared to GDMT (HR 5.324; 95% CI, 3.812-7.438; p<0.001).

Conclusions:
After PAD diagnosis, GDMT was associated with a lower incidence of mortality. This large-scale retrospective cohort analysis showed insufficient prevalence of GDMT among PAD patients.