bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14858: Revascularization Shows Beneficial Cardiovascular Outcomes in Severe Ischemic Cardiomyopathy: A Systematic Review and Meta-Analysis
Authors: Fatima Shumail , Hurera Abu , Torpoco Rivera Midori , Sezer Ahmet , Hickey Gavin W
Published: December 2023

Introduction:
Revascularization approach is historically prioritized over optimal medical therapy (OMT) for patients with severe stable ischemic cardiomyopathy (ICM) with ejection fraction < 35%. However, with advancement in OMT, recent studies have shown similar cardiovascular outcomes between the two strategies. Herein, we present a systematic review and meta-analysis examining the cardiovascular outcomes of revascularization strategies compared to OMT.

Research Question:
Is revascularization associated with improved cardiovascular outcomes in patients with severe stable ICM compared to OMT alone?

Methods:
PubMed, Embase, Cochrane, CT.gov, ICTRP were searched using the search terms “coronary artery bypass grafting (CABG)” or “percutaneous coronary intervention (PCI)” versus “OMT” and “ICM” or “heart failure (HF)” from inception till May 2023. Included studies compared all-cause mortality, cardiovascular mortality, HF-related deaths, acute myocardial infarction (AMI), stroke and HF hospitalization. Data were pooled into risk ratios (RR) using fixed-effects model.

Results:
3 studies (n= 2050, Revascularization = 1026 and OMT= 1024) met our inclusion criteria. The follow-up period ranged from 3.4-9.8 years. Revascularization strategies primarily through CABG had protective effects for all-cause mortality (RR 0.91, 95% CI 0.84-0.98, p= 0.01, I2 0%, N= 3 studies), cardiovascular death (RR 0.83, 95% CI 0.74-0.93, p=0.00, I2 0%, N= 2 studies) and HF hospitalizations (RR 0.80, 95% CI 0.69-0.93, p= 0.00, I2 19.20%, N= 2 studies). No significant differences were observed in risks of HF related deaths, AMI and stroke between the two strategies.

Conclusions:
Revascularization primarily through CABG reduces all-cause and cardiovascular mortality as well as HF hospitalizations in severe stable ICM. Further studies are warranted to determine which patients can derive the greatest advantages from revascularization.
Abstract 14862: Electrophysiological Predictors of Susceptible Atrial Substrate for the Onset and Recurrence of Atrial Fibrillation
Authors: Mayer Michael , Aziz Zaid , Deshmukh Amrish , Al Kassem Hatem , Beaser Andrew , Upadhyay Gaurav A , Emami Maryam , Ozcan Cevher
Published: December 2023

Introduction:
Atrial electro-anatomical substrate is essential for pathogenesis of atrial fibrillation (AF). Electrophysiological markers of AF susceptibility, however, are not well characterized. Identifying markers of atrial substrate has significant clinical implications in early detection and intervention for AF or stratifying patients at higher risk of AF recurrence following ablation.

Hypothesis:
We hypothesized that conduction indices on surface electrocardiogram (ECG) and intracardiac electrogram (EGM) may predict susceptibility and/or AF recurrence following ablation.

Methods:
We studied all consecutive patients who underwent electrophysiological study and catheter ablation for AF or atrioventricular nodal reentrant tachycardia (AVNRT) from 2013 to 2018. Atrial conduction indices were measured on ECG and EGM during the electrophysiology study. We evaluated correlations between both AF and AF recurrence with conduction indices, and associations between AF recurrence and conduction indices were evaluated with univariate logistic regression analyses and machine learning.

Results:
The study population included 387 patients with AF (mean age 63 years, 31% female) and compared to patients with AVNRT (n=94) who were considered as a control group. AF was associated with significant prolongation of all measured surface ECG and EGM parameters (p<0.05). During a mean follow up of 5±2 years, recurrence of AF (48%) after successful ablation occurred in patient with longer P wave duration, left atrial (LA) conduction duration, proximal to distal coronary sinus (pCS-dCS) interval, and P-dCS interval (p<0.05). Prolonged P wave duration, LA duration, pCS-dCS interval, and QRS duration were predictors of AF recurrence. Machine learning modeling determined that pCS-dCS interval, QRS duration, and LA duration (lead V1 and II) were the most impactful conduction indices for AF recurrence.

Conclusions:
Atrial conduction indices are markers of susceptible substrate for the onset and the recurrence of AF after successful ablation. LA conduction parameters can be used for risk stratification to facilitate early detection and management of AF.
Abstract 14863: Omega-3 Fatty Acids Intake and Oxylipins Production in Response to Short-Term Ambient Air Pollution Exposure in Healthy Adults
Authors: Tong Haiyan , Zhang Siqi , Chen Hao , Samet James
Published: December 2023

Rationale:
Exposure to air pollution is associated with adverse health effects through systemic inflammation and oxidative stress. One mechanism of beneficial effects of omega-3 polyunsaturated fatty acids (n-3 FA) is mediated via their inflammation resolution process by generating bioactive lipid mediators known as oxylipins.

Objective:
This study examined the association between n-3 FA-derived bioactive oxylipins and short-term exposure to ambient air pollution in healthy adults.

Methods:
Fifteen healthy adults were enrolled into either high or low n-3 groups based on n-3 FA intake and the participants underwent 4-5 blood collections for lipidomic profile of 55 oxylipins. Associations between ambient ozone, nitrogen dioxide (NO
2
), and fine particulate matter (PM
2.5
) levels and plasma oxylipins were assessed using mixed-effects models stratified by fatty acids levels.

Results:
Average concentrations of ozone (40.8±11.1 ppb), NO
2
(5.3±3.8 ppb), and PM
2.5
(10.2±4.1 μg/m
3
) were below national ambient air quality standards during the study period. Compared to the low n-3 group exposed to ozone and PM
2.5
, high n-3 group had significant reduction in arachidonic acids (AA) derived pro-inflammatory oxylipins produced by lipoxygenase (LOX). For instance, 12 HETE was negatively associated with ozone levels [for an IQR increase in ozone, -58.1% (95% CI:-96.8, -19.4) vs. 14.5% (95% CI:-33, 62)] and PM
2.5
concentrations [for an IQR increase in PM
2.5
, -29.6% (95% CI:-49.1, -10.1) vs. 28.5% (95% CI:-3.8, 60.9)] at lag4 in the high n-3 group while the association was null in the low n-3 group. In contrast, high n-3 group exposed to ozone and PM
2.5
had significant increases in EPA and DHA derived pro-resolving oxylipins produced by LOX and cytochrome p450 (CYP) and soluble epoxide hydrolase (sEH) compared to the low n-3 group.

Conclusions:
We observed negative associations between short-term ambient air pollutants and pro-inflammatory oxylipins in the high n-3 groups, while the associations between short-term ambient air pollutants and pro-resolving oxylipins were positive in the high n-3 groups, suggesting that n-3 derived lipid mediators may mediate the inflammation resolution process in response to low levels of ambient air pollution in healthy adults.
Abstract 14869: The Role of Female Sex Hormones in Dimorphism of the Immune System in Group 1 Pulmonary Hypertension
Authors: Lima Patricia D , Al-Qazazi Ruaa , Martin Ashley , Wu Danchen , Noordhof Curtis , Bentley Rachel E , Mewburn Jeffrey , Emon Isaac , Jones Oliver , Archer Stephen L
Published: December 2023

Background:
The right ventricle (RV) fails in pulmonary arterial hypertension (PAH) in part due to inflammation. In male PAH, RV CCR2
+
macrophages induce inflammation via NLRP3 inflammasome. Since PAH males have worse outcomes, a cardioprotective role of the female sex hormones is suggested.

Hypothesis:
Ovariectomy (OVX) in females recapitulates the males’ disease severity by increasing RV inflammation. NLRP3 inhibition ameliorates RV function in male and OVX rats with monocrotaline (MCT)-induced PAH.

Methods:
PAH was induced with MCT (60mg/kg) in male, female, and OVX female Sprague Dawley rats. 10 days post-MCT, rats (n=6/sex) were treated with the NLRP3 inhibitor, MCC950 (6mg/Kg/day). Control and MCT rats were studied (n=4/sex/group). RV function was assessed by echocardiography and high-fidelity hemodynamics. Inflammatory (His48
lo
CD43
lo
CCR2
+
) monocytes were quantified via flow cytometry, RV macrophages (CD68
+
CCR2
+
) and mitochondrial morphology were quantified by confocal microscopy. RV fibrosis and hypertrophy were measured.

Results:
MCT rats had higher RV systolic pressure (RVSP), reduced pulmonary artery acceleration time (PAAT), cardiac output (CO), and tricuspid annular plane systolic excursion (TAPSE)
vs.
controls (Table). The RV end-diastolic pressure (RVEDP) was high in MCT males, while RV-free wall thickening was reduced in males and OVX. MCC950 improved CO in MCT males but reduced RVSP in males and OVX. The number of CCR2
+
inflammatory monocytes (
p=0.065
) and RV macrophages (
p=0.007
) was higher in MCT males. Fragmented mitochondria (
p=0.004
), RV fibrosis (
p<0.0001)
and cardiomyocyte hypertrophy (
p<0.0001
) were present only in MCT males. MCC950 reduced fibrosis (
p=0.006
) and hypertrophy (
p<0.0001)
in males. MCC950 tended to improve hemodynamics in OVX.

Conclusion:
RV inflammation is most severe in males, and female sex hormones are cardioprotective. Inhibition of the NLRP3 is beneficial in MCT males and trend to benefit OVX.
Abstract 14941: Incidence of Cardiac Implantable Electronic Device Infections in End-Stage Kidney Disease Patients on Dialysis
Authors: Pothuru Suveenkrishna , Chan Wan-Chi , Jiwani Sania , gupta Kamal
Published: December 2023

Introduction:
Hemodialysis potentially increases the risk of cardiac implantable electronic device (CIED) infection due to transient bacteremia. There is limited available data on the incidence of CIED infections in patients with end-stage kidney disease (ESKD) on hemodialysis. The objective of this research was to study the 1-year incidence of device infection after a new CIED implant in hemodialysis patients.

Methods:
We conducted a retrospective observational analysis using the United States Renal Data System database. We identified patients aged >18 years with ESKD on hemodialysis who underwent first CIED implant between January 2006 and September 2014. ICD-9 codes were used and we excluded patients with a prosthetic valve. The primary outcome of the study was 1-year incidence of CIED infection. We analyzed the association of device infection with the type of CIED.

Results:
During the study period, a total of 46,209 patients with ESKD on dialysis received a CIED. After applying the exclusion criteria, 15,077 patients were included in the study. The mean age of the population was 69.9 years; majority were male (56.8%) and white patients (68.5%). Common comorbidities included hypertension (97.7%), dysrhythmia (75.7%), diabetes mellitus (71.1%), and congestive heart failure (67.7%). Of the included patients, 66.5% received a pacemaker (PPM), 33.1% received an implantable cardioverter-defibrillator (ICD), and 0.4% received cardiac resynchronization therapy (CRT-P or CRT-D). The overall 1-year incidence of CIED infection was 3.1%. The incidence of CIED infection was highest among patients with ICDs (4.2%), followed by CRT (3.7%), and PPM (2.5%) (p<0.0001).

Conclusions:
The 1-year incidence of CIED infections in ESKD patients on hemodialysis was 3.1%, which is significantly higher than the incidence reported in the general population. The highest incidence was observed in those with ICDs. These findings underscore the importance of monitoring and managing CIED infections in this population to improve patient outcomes.
Abstract 14947: Opportunities to Address Specialty Care Deserts and the Digital Divide: VA’s Virtual Hub-and-Spoke Cardiology Clinic
Authors: Tisdale Rebecca L , Purmal Colin , Kalwani Neil M , Sandhu Alexander T , Heidenreich Paul A , ZULMAN DONNA , Hussain Tanvir
Published: December 2023

Introduction:
Access to specialty care, including cardiology, in the Veterans Health Administration (VA) varies widely across geographic regions. VA’s clinical resource hub (CRH) model of care offers mostly-virtual specialty care to individuals in low access regions and has recently been implemented in cardiology.

Research Question:
How does implementation of a predominantly virtual care cardiology program through CRH affect the reach of cardiology specialty care in the VA?

Aims:
Describe the association between patient characteristics and use of CRH cardiology care in VA’s Sierra Pacific region (Northern California, Nevada, and the Pacific Islands).

Methods:
We compared patients who used CRH cardiology services between 7/15/2021 and 3/31/2023 to non-CRH Sierra Pacific cardiology patients, then used multivariate logistic regression to estimate the association between patient-level factors and odds of being a CRH user.

Results:
There were 798 CRH users over the study period with a total of 3,662 cardiology encounters, 1,690 of which were CRH encounters. Of these, 8% of CRH users were women and 41% were ≥75 years, compared to 4% and 48% respectively among non-CRH users [n=25,412 with 95,663 encounters]. Similar proportions in both groups were rural (26% CRH, 25% non-CRH), highly-disabled (48% CRH, 47% non-CRH), and low-income (20% in both groups). In multivariate logistic models, adjusted odds of using CRH were higher for women (adjusted odds ratio [AOR] 1.45 [95% CI 1.09-1.92]) and lower for older Veterans (AOR 0.44 for ≥75 [95% CI 0.0.32-0.61]).

Conclusions:
The Sierra Pacific CRH cardiology program served a disproportionately high number of women and similar proportions of rural, highly-disabled, and low-income Veterans in its first two years of operation. This predominately-virtual model of cardiology care may be an effective strategy for overcoming access barriers for certain individuals, though targeted efforts may be required to reach older Veterans.
Abstract 14953: Racial and Ethnic Disparities in Preterm Birth Among Individuals With Hypertensive Disorders of Pregnancy in the United States, 2020-2021
Authors: Peesay Tejasvi , Everitt Ian K , Shah Nilay S , Yee Lynn M , Khan Sadiya S , Cameron Natalie A
Published: December 2023

Introduction:
Preterm birth (PTB) is a common adverse outcome in pregnancies complicated by hypertensive disorders of pregnancy (HDP). PTB and HDP are each associated with higher risk of cardiovascular disease (CVD) in both the pregnant individual and their offspring. Racial and ethnic disparities have been described individually in PTB and HDP but the frequency of PTB among individuals with HDP, and whether differences exist by maternal race and ethnicity, is not known.

Methods:
We used cross-sectional data from the National Center for Health Statistics and included nulliparous individuals aged 15-44 years with a singleton, live birth who had new-onset HDP (gestational hypertension or preeclampsia) in the US in 2020 and 2021. We calculated the frequency of PTB (gestational age < 37 weeks) among those with HDP (%), overall and stratified by self-reported maternal race and ethnicity group (American Indian/Alaskan Native [AIAN], non-Hispanic Asian/Pacific Islander [API], Hispanic, non-Hispanic Black [NHB], non-Hispanic White [NHW]). We compared the frequency of PTB in each racial and ethnic group to the referent group (NHW) with age-standardized rate ratios (aRR).

Results:
Among 302,817 individuals with HDP, 0.7% were AIAN, 0.8% API, 18.7% Hispanic, 15.5% NHB, and 57.2% NHW. The frequency of PTB among individuals with HDP was 17.6% (95% 17.4-17.8) in 2020 and 18.0% (17.8-18.2) in 2021. Significant racial and ethnic differences were observed in the frequency of PTB with HDP in 2020 and 2021 (
Table
). In 2021, compared with NHW individuals, AIAN (aRR 1.2 [1.0-1.4]), Hispanic (aRR 1.1 [1.1-1.2]), and NHB (aRR 1.4 [1.3-1.4]) individuals had a significantly higher risk of PTB with HDP.

Conclusions:
In 2020-2021, nearly 1 out of 5 nulliparous individuals with HDP also experienced PTB. Identifying and addressing drivers of racial and ethnic differences in the co-occurrence of PTB and HDP may offer an opportunity to mitigate disparities in intergenerational CVD risk.
Abstract 14962: Rate of 30-Day Readmission and Economic Burden of Sickle Cell Disease Patients Who Underwent Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Procedure for ST Elevation Myocardial Infarction
Authors: Alzamara Muayad , Akinti Oluwasegun , Nworie Kenneth , Aiwuyo Henry , bada funlola , ORIGBEMISOYE ADESINA , Illah Catherine , Coello Patrick , Brennan Emmett , Kahn Alexa , Fatuyi Michael
Published: December 2023

Introduction:
Sickle cell disease (SCD) is an inherited disorder in which microvascular occlusion causes complications across multiple organ systems, including the heart. Heart problems are among the most common causes of death in people with SCD. Macrovascular complications can also transpire among SCD.

Hypothesis:
We sought to determine the 30-Day Readmission rate (30-DRr) of patients with SCD who underwent Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft (CABG) procedure for ST-Elevation Myocardial Infarction (STEMI) and its impact on mortality and healthcare utilization in the United States.

Methods:
Using the 2020 National Readmission Database, we conducted a retrospective analysis of patients with SCD after PCI and CABG for STEMI as a principal diagnosis according to ICD-10 codes. Readmission was the first admission to any hospital for any non-trauma diagnosis within 30 days of the index admission. The primary outcome was 30DRr, while secondary outcomes were readmission mortality rate and resource utilization defined by length of stay & patient charge.

Results:
77 index hospitalization was observed with a mean age of 57.4 SD± 4.2 years, and 70.6 % were females. The in-hospital mortality rate for index admission was 6.5% (5 of 77), while 30-DRr was 20.8% (15 of 72) (Figure 1). Among this group of readmitted patients (mean age was 61.2 SD± 10.5 years, & 57% were males), In-hospital mortality rate was 13.3% (2 of 15). However, observed 30-DRr among Non-SCD was 9.02% (36,564 of 405,526), which is lower, as well as lower inpatient index and readmission mortality of 4.81% (19,507 of 405,426) and 4.83% (1,764 of 36,564) respectively.

Conclusions:
Approximately 1 in 5 patients who underwent PCI and CABG procedures for STEMI with underlying SCD had 30-DRr. Readmission mortality was higher compared to index mortality but was not statistically significant. SCD patients are a vulnerable subset who will benefit from outpatient multidisciplinary care.
Abstract 14975: SIRT1 Ameliorates Cardiac Dysfunction Caused by Lamin A/C Deficiency via Mitochondrial Bioenergetics Improvement
Authors: Du Zunhui , Zhou Yanting , Xie Yuan , Yin Tong , Xie Yucai
Published: December 2023

Background:
The
LMNA
gene encodes lamin A/C and is the second most frequently mutated gene associated with dilated cardiomyopathy (DCM) but lacks effective therapeutic options. Recent transcriptomic studies have shown that mutation of
LMNA
leads to abnormal expression of genes related to mitochondrial function, however, the mechanisms have not been investigated further.

Hypothesis:
LMNA
protects against cardiac dysfunction via mitochondrial bioenergetics maintenance.

Aims
To decipher the mechanism by which
LMNA
mediates mitochondrial bioenergetics and DCM phenotype.

Methods:
Proteomics was performed to decipher the pathogenesis of DCM in
Lmna
-/-
mice. Neonatal rat ventricular myocytes (NRVMs) were used to dissect molecular mechanisms. Adenovirus and adeno-associated virus (AAV) were constructed to overexpress SIRT1
in vitro
and
in
vivo
, respectively.

Results:
Lmna
-/-
mice at 1 month of age showed obvious cardiac dysfunction, while 2-week-old
Lmna
-/-
mice showed no obvious cardiac phenotype. Proteomics revealed downregulated mitochondrial function-related pathways in
Lmna
-/-
hearts. Early injured mitochondria with decreased cristae density were detected and the only reduced mitochondrial biogenesis regulator SIRT1 was found in 2 week-old
Lmna
-/-
hearts. Overexpression of SIRT1 in lamin A/C knockdown NRVMs effectively improved mitochondrial oxidative respiration capacity. AAV-SIRT1 injection significantly alleviated mitochondrial injury, DCM phenotype of
Lmna
-/-
mice, and prolonged lifespan (Figure 1). Mechanistically,
LMNA
maintains mitochondrial bioenergetics through SIRT1-PARKIN axis.

Conclusions:
Lamin A/C deficiency leads to mitochondrial damage in cardiomyocytes and promotes the development of DCM through SIRT1 downregulation. Targeting SIRT1 ameliorates mitochondrial injury and DCM phenotype in
Lmna
-/-
mice, which may provide a novel therapeutic strategy for
LMNA
mutation-associated DCM.
Abstract 14992: Impact of Coronary Artery Disease on Rate vs. Rhythm-Control of Atrial Fibrillation
Authors: Chen Sunnia T , Desimone Christopher V , Del-Carpio Munoz Freddy , Kowlgi Gurukripa N , Deshmukh Abhishek
Published: December 2023

Introduction:
Atrial fibrillation (AF) is a common arrhythmia that can impair quality of life and increase cardiovascular mortality. Previous studies have shown potentially better outcomes with rate-control agents in patients with coronary artery disease (CAD). Yet, optimal treatment of AF is not yet known.

Methods:
Leveraging data from the AFFIRM trial, we performed a post-hoc analysis examining outcome differences in patients on rate vs. rhythm-control agents, based on CAD status. The primary outcome was defined as death from any cause; secondary outcomes included ischemic stroke, major bleeding, and hospitalization after baseline. Univariate and multivariate modeling were used to determine risk factors associated with designated outcomes.

Results:
Of 4060 patients enrolled, 1551 patients had CAD at baseline. There were no differences in treatment randomization based on CAD status; however, more patients with CAD had worse heart function and comorbid CHF. More patients with CAD ultimately used some form of rate-control compared to those without. Overall, CAD patients were more likely to experience death (HR 2.08 [1.79-2.42], P<0.001), specifically those on rhythm-control (HR 1.24 [1.01-1.52], P=0.04, Figure). CAD patients were also more likely to have ischemic stroke (HR 1.24 [1.00-1.53], P=0.05). When comparing CVD vs. non-CVD death, only CAD patients on rhythm-control exhibited a significantly higher rate of CVD death (HR 1.39 [1.03-1.89], P=0.03), while no differences in primary outcomes were noted for all other groups (P>0.05, Figure). In multivariate modeling, the effect of treatment arm on risk of CVD death in CAD patients diminished upon accounting for age, smoking, rhythm at randomization, first episode of AF, CHF, and LVEF<50% (HR 1.18 [0.93-1.50], P=0.17).

Conclusions:
AF patients with CAD on rhythm-control agents exhibited worse CVD outcomes, which may be more reflective of heart disease severity rather than treatment effects.
Abstract 150: Non-Linear Association Between the Time of Reaching the Targeted Temperature and the Neurological Outcome in Patients Undergoing Targeted Temperature Management After Out-of-Hospital Cardiac Arrest Observational Multicenter Cohort Study
Authors: Nishimura Tetsuro , Hatakeyama Toshihiro , Yoshida Hisako , Kiguchi Takeyuki , Okada Yohei , Mizobata Yasumitsu , Kitamura Tetsuhisa , Iwami Taku
Published: December 2023

Background:
We aimed to identify the most favourable time from the introduction of targeted temperature management (TTM) to achieving the targeted temperature in patients experiencing out-of-hospital cardiac arrest.

Methods:
This multicenter cohort study was performed using the Comprehensive Registry of Intensive Care for OHCA Survival study, we collected patients’ information, including that on in-hospital care. We enrolled all consecutive patients transported to participating institutions in Osaka, Japan from 1 July 2012 through 31 December 2017. Eligible were persons aged ≥18 years whose cardiac arrest was of cardiac etiology and who received in-hospital TTM. Primary outcome was favourable neurological survival with a Cerebral Performance Category scale of 1 or 2 one-month after cardiac arrest, which was designated as “one-month favourable neurological survival”. After adjusting for several factors, a non-linear multivariable logistic regression analysis assessed the time from the introduction of TTM to reaching the targeted temperature and the probability of the primary outcome. Also, we subdivided patients according to five quintiles based on the time from the introduction of TTM to achieving the targeted temperature. To compare the probability of the primary outcome among quintiles, a multivariable logistic regression analysis calculated adjusted odds ratios and 95% confidence intervals.

Results:
We analyzed 483 patients. p for non-linearity was <0.01 in the non-linear multivariable logistic regression analysis. In the first quintile (<26.7 minutes), second quintile (26.8-89.9 minutes), third quintile (90.0-175.1 minutes), fourth quintile (175.2-352.1 minutes), and fifth quintile (≥352.2 minutes), one-month favourable neurological survival was 32.6% (31/95), 40.0% (36/90), 53.5% (53/99), 57.4% (54/94), and 37.9% (36/95), respectively. Adjusted odds ratios with 95% CI for the primary outcome in the first, second, third, and fifth quintiles, compared with the fourth quintile as the reference, were 0.38 (0.20 to 0.72), 0.43 (0.23 to 0.81), 0.77 (0.41 to 1.44), and 0.46 (0.25 to 0.87), respectively.

Conclusions:
Time to reaching the targeted temperature was associated with favourable outcome in patients with cardiac arrest.
Abstract 15002: Cardiovascular Disease Risk Prediction by Random Survival Forest: The Korean National Health Insurance Service-National Health Screening Cohort
Authors: Park Sooyoung , Ratcliffe Sarah , Bowles Kathryn , Ulrich Connie M
Published: December 2023

Introduction:
Risk prediction is critical for cardiovascular disease (CVD) prevention and management. Existing CVD risk prediction models including the Framingham Risk Score (FRS) are based on the Cox proportional hazard ratio regression. Adaptation of a data mining approach could improve the accuracy of CVD risk prediction by being free from the linearity assumption. The aim of study was to construct Korean population-based CVD risk prediction models using random survival forest and to compare their predictive accuracy to the FRS in a 14-year Korean cohort.

Methods:
This was a secondary data analysis using a Korean population-based cohort. Out of 463,783 eligible participants, 70% were selected for training dataset using stratified random sampling, and the remaining 30% served as test dataset. Random survival forest was adopted to build risk prediction models using the training dataset. The test dataset was used to test the validity of the new models and the FRS.

Results:
Three random forest-based models were developed, and they were good in discrimination in both men and women with the c-statistics ranging from 0.698 to 0.747 while the c-statistics for the FRS were 0.692 and 0.733 in men and women, respectively. All random forest-based models showed good calibration, whereas the FRS tended to overestimate the CVD risk for men.

Conclusions:
The random survival forest-based models showed comparable performance with the FRS in a Korean population-based cohort. Continuous efforts are needed to improve the accuracy of CVD risk prediction for the Korean population and to utilize CVD risk prediction in clinical practice.
Abstract 15009: Extra-Low Energy Defibrillation With Epicardial Implantable Cardioverter Defibrillator Networks With Electrically Conductive Fibers in Disease Models
Authors: Akita Toshiaki , Hisada Toshiaki , Akita Sho
Published: December 2023

Introduction:
We previously reported that extra-low energy (<0.6J) defibrillation is possible with the epicardial ICD net lead system (Ep-ICD) in normal canine hearts.

Hypothesis:
The aim of this study was to test whether the Ep-ICD can terminate ventricular fibrillation (Vf) with the same energy in two disease models (heart failure and long QT syndrome (LQT)).

Methods:
1. Ep-ICD was constructed by fine tungsten fibers at the top and bottom of the cardiac mesh (Figure 1), connected to the RV and SVC coils of the DF-1 lead, respectively. 2. Heart failure was induced by rapid right ventricular pacing (170 bpm, 8 weeks). 3. Vf was induced by placing a 9V battery on the surface of the heart. DC shock was delivered with a minimum energy of 0.4J (Medtronic Viva XT). 4. Defibrillation threshold (DFT) was defined as 75% of defibrillation success. 5. LQT was simulated by reducing the conductance (Gk) of the IKS current by (x 1.0(CTL) or 0.8(LQT)) by computer simulation.

Results:
1. DFT(J) of Ep-ICD in the canine HF model: 0.8, 1.2, 1.2. 3, Minimum DF energy(J): 0.6, 0.6, 0.8, 2. Maximum DF energy(J): 1.2, 1.6, 5, 52. Immediate return to sinus rhythm (SR) was achieved in most cases after DC delivery. In a small number of cases, brief periods of VT occurred, with rapid return to SR. No tachycardic arrhythmias occurred after return to SR. 3. The DFT was 0.39 for LQT and 0.52 for CTL.

Conclusions:
1. DFT of Ep-ICD increased from 0.6 J in normal canine heart to 1.2 J in canine HF model, but still much lower energy used in current ICD system (36 J). 2. The Ep-ICD lead system is the least traumatic and still within the acceptable range while conscious. 3. DFT of LQT with Ep-ICD is 25% lower than normal heart. 4. Ultra-low energy DC can avoid conduction abnormalities or malignant arrhythmias after shock. Hearts return to SR immediately. 5. Ep-ICD can deliver the DC shock before loss of consciousness, improving quality of life and safety of ICD therapy.
Abstract 15052: The Association Between Sleep Duration With Cardiovascular Disease and All-Cause Mortality: Results From the National Health and Nutrition Examination Survey (NHANES)
Authors: Allouch Farah , Peacock Erin , Mills Katherine T , Bundy Joshua D , Tian Ling , Chen Jing , He Jiang
Published: December 2023

Background:
In 2022, the American Heart Association (AHA) updated the list of modifiable lifestyle factors most important for cardiovascular health to include sleep. Sleep disturbances, such as insomnia and sleep apnea, have been associated with an increased risk of incident cardiovascular disease (CVD). However, the relationship between sleep duration and mortality remains to be fully elucidated.

Methods:
We used National Health and Nutrition Examination Survey (NHANES) data linked to National Death Index records to examine the association between sleep duration and CVD and all-cause mortality. A representative sample of 37,975 adults aged ≥20 years participated in the survey, which included assessments of social, behavioral, and metabolic factors, including usual weekday sleep duration. Sleep duration was categorized as (1) ideal (6-<9 hours); (2) insufficient (<6 hours); and (3) excessive (≥9 hours). Cox proportional hazards regression models were used to determine the relationship between sleep duration and CVD and all-cause mortality. Models were adjusted for age, sex, and race.

Results:
Over an average of 7.5 years of follow-up, 2,406 CVD deaths were confirmed. In adjusted models, compared to ideal sleep duration (6-<9 hours), excessive sleep (≥9 hours) was associated with a 65% increase in CVD mortality (HR = 1.65; 95% CI: 1.39, 1.96), a 53% increase in cerebrovascular disease mortality (HR = 1.53; 95% CI: 1.22, 1.92), and a 52% increase in all-cause mortality (HR = 1.52; 95% CI: 1.40, 1.66). Insufficient sleep (<6 hours) was associated with a 38% increase in CVD mortality (HR = 1.38; 95% CI: 1.08, 1.75) and a 54% increase in all-cause mortality (HR = 1.54; 95% CI: 1.38, 1.71).

Conclusion:
We found that both insufficient and excessive sleep were associated with increased risk of CVD and all-cause mortality, and the risk was more pronounced for excessive sleep. These findings emphasize the importance of recognizing sleep as a modifiable risk factor for CVD. Further research is needed to explore the relationship between sleep and CVD, including incorporating sleep quality into risk assessments and defining clinically meaningful categorizations of sleep metrics.
Abstract 15068: Connexin43 Concerns Arrhythmias Through Changes in Mitochondrial Ca
2+
and ROS
Authors: Okumura Tsuyoshi , Takeda Kao , Koyama Sana , Akazawa Shiori , Shindoh Chiyohiko , Sato Haruka , Miura Masahito
Published: December 2023

Introduction:
Connexin43 (Cx43) is a connexin that forms gap junctions in hearts and exists as hemichannels in the inner mitochondrial membrane (mCx43). It is still unknown whether mCx43 is involved in the occurrence of arrhythmias. Thus, we examined whether deficiency of Cx43 increases arrhythmias and what roles mitochondrial Ca
2+
and ROS play in the occurrence of arrhythmias.

Methods:
Cardiac-specific Cx43-deficient (

Cx43
-/-

) mice were generated by crossing

Cx43
flox/flox

mice with α-myosin heavy chain

cre
+/-

mice. The resulting offspring,

Cx43
-/-

mice and their littermates (

Cx43
+/+

mice), were used. Trabeculae were dissected from mouse hearts. Force was measured with a strain gauge, mitochondrial Ca
2+
with rhod-2, and mitochondrial ROS with MitoSox Red. The spatial distribution of rhod-2 and MitoSox Red imaged with confocal microscopy was similar to that of MitoTracker Green within trabeculae, meaning that rhod-2 and MitoSox Red are loaded within mitochondria. MitoSox Red fluorescence was measured before (Fl) and after the addition of 10 mM H
2
O
2
(FlH
2
O
2
), and the ratio of Fl to FlH
2
O
2
was calculated. To estimate arrhythmogenesis, the minimal extracellular Ca
2+
concentration (Cao), at which arrhythmias were induced by electrical stimulation (0.3-s stimulus intervals for 30 s), was determined (Cao
min
).

Results:

Cx43
-/-

mice died within 8 weeks (p<0.01). Cx43 was present in the inner mitochondrial membrane in

Cx43
+/+

mice but not in

Cx43
-/-

mice. In

Cx43
-/-

mice, rhod-2 fluorescence was higher than that of

Cx43
+/+

mice (n=7, p<0.01), while developed force of

Cx43
-/-

mice was similar to that of

Cx43
+/+

mice. The Cao
min
in

Cx43
-/-

mice was lower than that in

Cx43
+/+

mice (n=5, p<0.01), suggesting that

Cx43
-/-

mice shows increased arrhythmogenesis. In

Cx43
-/-

mice, Ru360 (5 μM), a mitochondrial calcium uniporter inhibitor, increased the Cao
min
, that is, decreased arrhythmogenesis, with decreases in rhod-2 and MitoSox Red fluorescence (n=6, p<0.05). Antioxidant peptide SS-31 (50 μM) and N-acetyl-L-cysteine (1 mM) increased the Cao
min
in

Cx43
-/-

mice (n=5, p<0.05), and the ratio of Fl to FlH
2
O
2
in

Cx43
-/-

mice was larger than that in

Cx43
+/+

mice.

Conclusions:
Deficiency of Cx43 increases arrhythmogenesis with increases in mitochondrial Ca
2+
and ROS.
Abstract 15070: Predicting Steam-Pop Incidence Using Ex-Vivo Bipolar Ablation Model of Porcine Ventricular Myocardium
Authors: Okuyama Takafumi , Makimoto Hisaki , Kamioka Masashi , Watanabe Tomonori , Watanabe Hiroaki , Yokota Ayako , Komori Takahiro , Kabutoya Tomoyuki , Imai Yasushi , Kario Kazuomi
Published: December 2023

Introduction:
Bipolar ablation has been reported to be able to create deep myocardial ablation lesion as compared to unipolar ablation, however, the incidence of steam-pop can lead to undesirable periprocedural complication.

Hypothesis:
Steam-pop occurrence during bipolar ablation can be predicted by the settings of bipolar ablation and the myocardial tissue characteristics such as tissue thickness and initial impedance prior to RF.

Methods:
Using porcine cardiac tissues ex-vivo ablation experiments were conducted. We adopted the commercially available radiofrequency (RF) ablation catheters. Each ablation catheter was placed on both sides of the myocardial slice at an angle of 45 degrees under targeted contact force of 10g. We recorded the occurrence of steam-pop under the multiple settings of tissue thickness, RF power and ablation duration. We created a generalized linear model (GLM) to predict steam-pop based on the bipolar ablation settings and the myocardial tissue characteristics.

Results:
In total 194 bipolar applications were analyzed. Steam-pops were observed in 11 out of 194 applications (5.7%). In the applications with steam-pop, the RF energy was higher (median 40W [q1-q3: 30-50] vs 30W [20-40], P=0.017), the initial impedance was lower (88 [86.75 - 91.5] vs 93 Ohm [89.75 - 95.75], P=0.0042) and the tissue thickness was thinner (9.4 [8.43 - 9.89] vs 12.9 mm [10.06 - 15.47], P<0.0001) as compared to the applications without steam-pop. Using tissue thickness, RF energy and initial impedance, the constructed GLM achieved sensitivity of 100%, specificity of 93% and the area under the receiver-operator-characteristics curve of 0.969.

Conclusion:
Our data showed that the steam-pop occurrence during bipolar ablation may be predicted based on the initial RF settings and the tissue characteristics in the ex-vivo porcine myocardial model. Further studies are necessary to validate the feasibility of predicting steam-pops using the RF and tissue characteristics in the beating heart and human heart, which may enable us to titrate the RF settings and lead to safer bipolar ablation.
Abstract 15100: Long-Term Clinical Outcomes Following Percutaneous Coronary Intervention in the Super Elderly Patients Aged Over 90 Years
Authors: TOKUDA KOTARO , Tanaka Akihito , Murohara Toyoaki , Ishii Hideki , Yoshioka Naoki , Tanaka Miho , Tashiro Hiroshi , Shibata Naoki , yamaguchi shogo , iwama makoto , Yoshida Luka , Tatami Yosuke , Umemoto Norio , Uemura Yusuke , Sakaguchi Teruhiro , Negishi Yosuke
Published: December 2023

Background:
In aged society, percutaneous coronary intervention (PCI) for super-elderly patient is not rarely performed in clinical practice. However, data regarding the clinical features and outcomes among the population are still limited.

Aim:
To investigate the patient characteristics and long-term clinical outcomes in nonagenarians who underwent PCI.

Methods:
This was a multicenter observational study, enrolling 402 nonagenarian patients who underwent PCI across 10 hospitals between 2011 and 2020. This study included the patients presented with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). Clinical outcomes including the occurrence of all-cause and cardiac deaths were investigated.

Results:
In overall 402 patients (mean age 91.9±2.0 years, 48.3% male), regarding coronary risk factors, 74.6% had hypertension, 25.4% diabetes mellitus, and 56.7% dyslipidemia. Majority of patients (77.9%) were ACS, mainly ST-segment elevation myocardial infarction (53.2%), and 22.1% CCS. During hospitalization [median 14 days (interquartile range, 6-25 days)], in-hospital death occurred in 12.4%. The rate was significantly higher in ACS patients than CCS patients (15.3% vs. 2.2%, p<0.001). The cause of death was mainly cardiac death (96.0%). The median follow-up period was 544 days (interquartile range, 72-1171 days). The estimated cumulative incidence rates of all-cause death were 24.3%, 39.5% and 60.4% at 1-year, 3-years, and 5-years respectively. The rates of cardiac death were 18.0%,26.5% and 39.2% at 1-year, 3-years, and 5-years, respectively. No significant difference was observed in the occurrence of all-cause death between the patients with ACS and CCS. Regarding causes of death after discharge, 44.1% were cardiac causes mostly account for heart failure and sudden death, and 55.9% were non-cardiac causes mainly account for infection and cancer.

Conclusion:
This study highlights the clinical features and long-term clinical course of nonagenarian patients who underwent PCI in the real-world setting. The patients presented with ACS had higher rate of in-hospital death than CCS, and the cumulative mortality increased approximately linearly after discharge, regardless of ACS or CCS.
Abstract 15109: Percutaneous Coronary Intervention During the Global Shortage of Iodinated Contrast
Authors: Mitchell Brian K , Gertz Zachary M , Kontos Michael C , Teman Nicholas , Norman Anthony , Ahmad Raza , Strobel Raymond , Damluji Abdulla A , Speir Alan , Short Robert , Quader Mohammed
Published: December 2023

Background:
A recent coronavirus-related factory shutdown led to a global shortage of iodinated contrast media. Its impact on percutaneous coronary interventions (PCI), which require contrast, has not been investigated.

Research Question:
The purpose of the study was twofold: (1) to evaluate the impact of the contrast shortage on PCI procedure volumes, patient and procedure characteristics and (2) to evaluate whether those changes impacted patient outcomes, especially acute kidney injury (AKI).

Methods:
Using CathPCI registry data from 19 Viriginia hospitals, we evaluated two time periods: pre-shortage (May 2021 - April 2022) and during the contrast shortage (May 2022 - October 2022). We compared procedure volumes, patient and procedure characteristics, and short-term outcomes. Of primary interest was whether a reduction in contrast would reduce the incidence of AKI.

Results:
There were 8,980 patients in the pre-shortage period and 4,046 during the shortage. Procedure volumes per hospital and patient characteristics remained similar. Multivessel procedures declined during the shortage (45.3% vs. 42.8%, p=0.007). There was a sharp decline in contrast per procedure during the shortage (149.9 ± 68.1 mL per case to 137.5 ± 62.4 mL (p<0.0001) that began at the start of the shortage and then continued throughout. There were no differences in patient outcomes, including AKI (7.9% versus 7.4%, p=0.40), between study periods. When limited to patients at increased risk of AKI, there remained no difference in AKI between the study periods, despite a similar decrease in contrast volume in that cohort. Multivariable analysis showed strong correlation between baseline risk of AKI and subsequent AKI (p<0.0001), but no impact of procedure characteristics or the timing of the PCI.

Conclusions:
The global shortage of iodinated contrast led to a significant decline in contrast use during PCI, with no impact on patient outcomes.
Abstract 15112: Characteristics and Clinical Outcomes of Patients With Sarcoidosis Admitted for ST-Elevation Myocardial Infarction
Authors: Ahmad Hasan , Ramphul Kamleshun , Ahmed Raheel , Hasan Ali , Farhan Muzammil , Hassan Azeem , Okafor Joseph , Carver Caleb , Durrani Taimurzeb , Jadoon Ayesha , Amanullah Khadija , Jamil Yumna , Bilal Maham , Ahmed Sajeel , Memon Rahat A , Sakthivel Hemamalini
Published: December 2023

Background:
Multisystem involvement is often seen in sarcoidosis. This study aims to explore the characteristics and clinical outcomes following hospitalization for ST-elevation myocardial infarction (STEMI) in patients with sarcoidosis when compared to patients without sarcoidosis.

Methods:
Patients with and without sarcoidosis admitted for STEMI were identified and compared from the 2016-2020 National Inpatient Sample (NIS) database whilst adjusting for confounders via logistic regression models.

Results:
A total of 851290 patients hospitalized with a primary diagnosis of STEMI between 1
st
January 2016 to 31
st
December 2020 were identified. Around 1215 (0.1%) had a diagnosis of sarcoidosis consisting of 58.4% males. When compared to patients without sarcoidosis, patients with sarcoidosis had a longer mean length of stay (LOS: 4.76 vs. 4.01 days, p<0.01), a greater prevalence of diabetes (42.4% vs. 32.4%, p<0.01), cirrhosis (1.6% vs. 0.5%, p<0.01), depression (9.1% vs. 6.7%, p<0.01), peripheral vascular disease (7.8% vs. 5.1%, p<0.01), obesity (24.3% vs. 17.8%, p<0.01), chronic kidney disease (25.9% vs. 13.1%, p<0.01) and prior stroke (7.4% vs. 5.2%, p<0.01). However, patients without sarcoidosis had a higher incidence of percutaneous coronary intervention (PCI) (79.8% vs. 75.3%, p<0.01), smoking (52% vs. 35.4%, p<0.01), drug abuse (2.8% vs. 1.2%, p<0.01) and alcohol abuse (3.5% vs. 2.1%, p<0.01) (Table 1A). Moreover, patients with sarcoidosis were less likely to have cardiogenic shock during their hospitalization (12.3% vs. 13.7%, aOR 0.768, 95% CI 0.636-0.927, p<0.01). No statistically significant differences were seen for CABG or PCI use, events of Acute Kidney Injury, acute ischemic stroke and death (Table 1AB).

Conclusion:
Patients with sarcoidosis admitted for STEMI had a longer length of stay and fewer cardiogenic shock incidence when compared to patients without sarcoidosis. Complications and mortality was otherwise comparable.
Abstract 15144: The Heartline Experience: Can Digital Health Technology Trials Achieve Long-Term Participant Engagement?
Authors: Nikolovski Janeta , Navar Ann Marie , Steinhubl Steve , Baca-Motes Katie , Curtis Anne B , Peterson Eric D , Lakkireddy Dhanunjaya , Tarino Michael , Juan Stephanie , Damaraju CV , Wentworth Dereck , Patel Mithun , Tavakoli Cammie , Gibson Charles M , Spertus John
Published: December 2023

Background:
Digital health technologies can potentially streamline clinical research and reach broad and diverse populations, yet they often fall short to achieve long-term participant engagement.

Research Question:
Can long-term participant engagement in a large, direct-to-participant randomized trial using an entirely decentralized trial platform be achieved?

Methods:
Heartline (www.heartline.com) was designed to test the impact of a mobile app-based heart health program with the electrocardiogram (ECG) and Irregular Rhythm Notification (IRN) features on Apple Watch for early diagnosis, treatment, and outcomes of atrial fibrillation (AF). The custom app collected electronic patient-reported outcomes (ePROs) and incorporated engagement strategies based on behavioral science principles and features relevant to the target study population, including a simple interface and actions, weekly curated health education, and points-based incentives. Participants who received an IRN from their Apple Watch were prompted to take an ECG and follow up with their healthcare provider (HCP).

Results:
From 02/2020 to 12/2022, Heartline enrolled 34,245 US participants ≥65 years of age. To date, 80% and 76% of the study population used the app at least monthly after 1 and 2 years, with weekly engagement rates of 68% and 66%, respectively (
Figure
). ePRO response rates were 88% at 1 year and 91% at 2 years. Of those receiving an IRN, 85% took an ECG recording and 71% reported follow up with their HCP.

Conclusions:
The Heartline study achieved high rates of sustained, longitudinal engagement, with >75% of the study population remaining engaged over 2 years and >90% completing ePROs, representing substantially higher engagement rates than prior remote digital health studies. A combination of strategies was used to promote engagement in Heartline. Further work to identify the key drivers of engagement will inform future decentralized trials and digital therapeutics.