bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17045: Investigating the Causal Relationship Between Glycemic Trait and Great Vessels Structures Using Mendelian Randomization
Authors: Daria Tselmen , Alkhairo Hasan , Levin Michael , Damrauer Scott M , Tsao Philip S , Priest James , Pirruccello James , Echouffo Justin B , Tcheandjieu Catherine
Published: December 2023

Introduction:
Diabetes has been inversely associated with aortic aneurysm. However, it remains unclear whether this relationship is causal. In this study, we investigated the relationship between diabetes and glycemic traits, and MRI-derived measures of the great vessels (aortic and pulmonary artery) morphologies using Mendelian randomization (MR).

Methods:
We employed an inverse-variance weighted method to conduct a two-sample MR analysis using summary statistics from genome-wide association studies of glycemic traits (fasting insulin [FI], fasting glucose [FG], glycated hemoglobin [HbA1c], 2-hour glucose after oral challenge [2hGlu], and type 2 diabetes [T2D]) and MRI-derived measures of aortic morphology including ascending and descending aortic diameters (AAoD and DAoD), aortic distensibility (AoDist), aortic strain (AoStr), and pulmonary artery diameter (PAD). Sensitivity analysis was performed using the MR-Egger method, and pleiotropy was assessed using the MR-PRESSO method.

Results:
We observed evidence for associations between glycemic traits and aortic measures. Regarding aortic diameter, genetically predicted increases levels of 2hGlu, FG, and HbA1c were associated with decreased AAoD (2hGlu β = -0.11, p < 0.05; FG β = -0.15, p = 0.0002; HbA1c β = -0.18, p = 0.01) and DAoD (2hGlu β = -0.09, p < 0.001; FG β = -0.17, p = 0.0002; HbA1c β = -0.09, p = 0.02). No significant associations were observed between FI or T2D and both measures. We found that a genetically predicted increase in FI was associated with decreased AoStr (β = -0.23, p = 0.002) and AoDist (β = -0.18, p = 0.02), while a genetically predicted increase in HbA1c was associated with an increased AoStr (β = 0.18, p = 0.0008) and AoDist (β = 0.12, p = 0.03). Lastly, increased levels of FG and HbA1c were associated with an increase in PAD (FG β = 0.11, p = 0.02; HbA1C FG β = 0.25, p = 0.001).

Conclusions:
The genetic evidence supports the effects of glycemic traits on the aortic vasculature, providing additional causal evidence to support the epidemiological evidence linking high glucose exposure to aortic aneurysm. Further research is needed to better understand the mechanisms underlying these relationships.
Abstract 17049: Specific Subspecies of High Density Lipoprotein are Associated With Arterial Stiffness in Youth With and Without Diabetes
Authors: Vaisar Tomas , Thornock Carissa , Isom Scott , Jensen Elizabeth T , Pihoker Catherine , Dagostino Ralph , Wadwa Paul P , Urbina Elaine M
Published: December 2023

Introduction:
Early vascular aging (EVA), a risk factor for cardiovascular disease (CVD), is evident in youth with diabetes. The mechanisms responsible for EVA are not well understood. Causal relationship of HDL-C with CVD is doubtful, but HDL particle concentration (HDL-P) and HDL function (cholesterol efflux capacity, CEC) are associated with incident and prevalent CVD independent of HDL-C. We investigated whether these metrics associate with EVA in youth.

Methods:
We studied three cohorts of youth with T1D (n=173), T2D (n=214) and healthy controls (n=116). We quantified total HDL-P and 6 HDL subspecies by differential ion mobility, serum HDL CEC (total and ABCA1-specific), and investigated their association with arterial stiffness (tonometric carotid-femoral pulse wave velocity, PWV) with multivariate regression.

Results:
PWV was not associated with total HDL-P in any of the three groups, but was associated positively with concentration of extra-small (xsHDL, 7.6nm, r=0.22, P=0.004) in T1D, small (sHDL, 8.2nm) particles in T1D (r=0.31, P<0.0001) and T2D (r=0.17, P=0.02), and negatively with large HDL particles (lHDL, 11.5 nm) in T1D (r=-0.19, P=0.01). None of the HDL subspecies associated with PWV in healthy subjects. The association of sHDL with PVW remained significant after adjustment for age, sex, BMIz, mean arterial pressure (MAP), and diabetes status when analyzing T1D and controls or T2D and control subjects (Table 1). Both HDL-CEC metrics were significantly associated with higher PWV in T1D cohort but not T2D cohort, however, in multivariate models neither remained significant after adjusting the model for MAP (Table 1).

Conclusions:
A specific population of small HDL particles, but not HDL CEC, is associated with EVA, a predictor of CVD, independent of traditional risk factors and distending pressure (MAP). How the small HDL particles relate to EVA and whether they may be a novel target for intervention to prevent EVA in youth remains to be investigated.
Abstract 17053: Impact of Sodium-Glucose Cotransporter-2 Inhibitors on Mortality in Hypertrophic Cardiomyopathy: A Retrospective Study
Authors: Aglan Amro , Fath Ayman , Eldaly Abdullah , Phillips Jason , Anderson Allen S , Maron Barry J , Maron Martin , Rowin Ethan J
Published: December 2023

Background:
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been demonstrated to improve outcomes in congestive heart failure (HF). However, their effect in hypertrophic cardiomyopathy (HCM) is unknown.

Research Question:
Can SGLT2i improve clinical outcomes in HCM patients?

Methods:
Using TriNetX Global Research Network from March 2013 to February 2021, patients diagnosed with HCM (ICD-10 codes I42.1, I42.2) were identified and categorized into 2 groups: those on SGLT2i vs. those who are not. To avoid inclusion of other causes of left ventricular hypertrophy, patients with aortic stenosis or systemic hypertension were excluded. Propensity score matching (PSM) was used to limit confounders. Primary outcome was all-cause mortality and secondary outcomes were HF exacerbation, all-cause hospitalization, and documented cardiovascular symptoms (chest pain, dyspnea, palpitations, or leg edema) over a 2-year follow-up period.

Results:
A total of 27,561 HCM patients were identified; 408 (1.5%) on SGLT2i and 27,153 (98.5%) were not. Patients on SGLT2i were older (55 ± 15 vs. 48 ± 19, p<0.01) and had more comorbidities, including a nearly 6-fold higher prevalence of diabetes mellitus (44% vs. 7%, p<0.01) and congestive HF (65% vs. 10%, p<0.01). After PSM, each group consisted of 355 patients. HCM patients on SGLT2i had lower rates of all-cause mortality (OR 0.22 [95% CI: 0.12, 0.39]; p<0.01), hospitalizations (OR 0.72 [95% CI: 0.53, 0.98]; p=0.04), and cardiovascular symptoms (OR 0.71 [95% CI: 0.52, 0.97]; p=0.029) when compared to patients not on SGLT2i. There was no statistical difference in the rate of HF exacerbation (OR 0.82 [95% CI: 0.54, 1.24]; p=0.3).

Conclusion:
In this large dataset, SGLT2i use in a select subset of HCM patients was associated with improved survival, less hospitalizations, and fewer cardiovascular symptoms. These data support future randomized trials to evaluate the efficacy and safety of SGLT2i in more diverse HCM patient populations.
Abstract 17069: Efficacy and Safety of Pulsed Field Ablation For Atrial Fibrillation: A Systematic Review and Meta-Analysis
Authors: Qamar Usama , Agarwal Siddharth , Krishan Satyam , Asad Zain Ul Abideen
Published: December 2023

Introduction:
Pulsed-field ablation (PFA) is a novel ablation modality to treat atrial fibrillation (AF) with high tissue selectivity and thereby potentially lesser complications compared to thermal ablation.

Hypothesis:
We aimed to analyze the efficacy and safety of PFA in the treatment of AF.

Methods:
A systematic search of Embase, Medline, Scopus, and Web of Science was conducted from inception till May 2023 to identify all the studies that included patients undergoing pulsed field ablation for the treatment of AF. We pooled outcomes using a random-effects model. All analyses was performed using the OpenMetaAnalyst software.

Results:
A total of 24 studies including 2,256 patients met our inclusion criteria. Acute isolation of all pulmonary veins was achieved in 99.7% of all patients (95% confidence interval (CI): 99.4%-99.9%; I
2
: 0%). The average total procedure time was 81 (95% CI: 69-93; I
2
: 99%) minutes, and the average fluoroscopy time was 14 (95% CI: 12-16; I
2
: 98%) minutes. The overall complication rate was 2.9% (95% CI: 1.4%-4.0%; I
2
: 71%). At a mean follow-up of 6.6 months, the overall rate of arrhythmia recurrence after the blanking period of 90 days was 17% (95% CI: 11%-24%; I
2
: 94%).

Conclusion:
PFA has a high procedural success with low complication and recurrence rates. Further randomized controlled trials are needed to compare its long-term efficacy and safety against conventional ablation techniques.
Abstract 17077: Pulmonary Artery Compliance: Resistance is (Not?) Futile
Authors: DesJardin Jacqueline T , Broerman Matthew J , Saul Melissa , Nouraie Mehdi , Simon Marc A
Published: December 2023

Introduction:
Small studies have suggested that low pulmonary artery compliance (PAC) — quantified by dividing stroke volume by the pulmonary artery pulse pressure — is an early indicator of pulmonary hypertension (PH). However, the relationship between PAC and mortality, and the clinical utility of PAC in all-comers remains in question.
Research Questions:
How does the risk of mortality in all-comers change with PAC? Does the PAC provide prognostic information over established hemodynamics (i.e., pulmonary vascular resistance [PVR], mean pulmonary artery pressure [mPAP])?

Methods:
Analysis was conducted on adult patients undergoing right heart catheterization at the University of Pittsburgh Medical Center Presbyterian Hospital 2005 - 2020, excluding those with prior heart/lung transplant, ventricular assist devices, and missing/non-physiologic hemodynamics. A cubic spline model was constructed to describe the relationship between PAC and the predicted risk of death. Multivariable Cox models for mortality were compared by plotting the distribution of 100 Harrell’s Concordance indices derived from Monte Carlo cross-validation. The fully-adjusted model was compared to models with one variable removed, thereby assessing the relative contribution of the withdrawn variable to model performance.

Results:
The cohort included 12,948 patients (median age 64, 55% male, 84% White); 29% had combined post- and pre-capillary PH, 24% pre-capillary PH, and 17% isolated post-capillary PH. The predicted risk of mortality 1) increased linearly as PAC decreased below 3 mL/mmHg, 2) tapered for PACs between 3 - 5 mL/mmHg, and 3) remained constant at PACs above 5 mL/mmHg (Figure 1). Removal of PAC from Cox models predicting mortality did not substantially affect model performance (Figure 2).

Conclusions:
A PAC below 5 mL/mmHg, and especially below 3 mL/mmHg, is associated with increased mortality; however, PAC does not improve prognostic information over the mPAP and PVR.
Abstract 17085: An Unusual Case of Severe Hypertrophic Cardiomyopathy in a 23-Year-Old Systemic Lupus Erythematosus Patient on Hydroxychloroquine
Authors: Brown Bernard , Adam Budzikowski , john sabu
Published: December 2023

A 23-year-old female with Systemic lupus erythematosus (SLE), lupus nephritis, antiphospholipid syndrome, venous thromboembolism, stroke, Libman-Sacks endocarditis, and hypertension presented with right upper and lower extremity weakness, right facial droop, and aphasia. Her home medications included hydroxychloroquine, mycophenolate, apixaban, and losartan. ECG showed normal sinus rhythm, left atrial enlargement, ST and T wave abnormalities in V5 and V6. Computed tomography angiography of the brain showed left middle cerebral artery occlusion. Transthoracic echocardiogram (TTE) showed left ventricular ejection fraction of 65%, severe left ventricular hypertrophy, moderate pericardial effusion, and moderately thickened mitral valve (MV) leaflets. Transesophageal echocardiogram showed large vegetations on atrial aspect of both MV leaflets concerning for Libman-Sacks endocarditis. We attempt to investigate the cause of this hypertrophic cardiomyopathy (HCM) in a young patient with SLE. Few reported cases of HCM in patients with SLE were medication induced. Tacrolimus has been observed to induced HCM in a Japanese patient with dermatomyositis. Hydroxychloroquine has been associated with myocardial thickening. Its use can lead to enlarged myocardiocytes with intracytoplasmic vacuoles consisting of concentric lamellar myelin figures in single membrane bound vesicles, curvilinear bodies, glycogen accumulation and fused mitochondria. Hydroxychloroquine use led to reversible inhibition of lysosomal enzyme activity. Cessation of medication use in both cases led to reduction in left ventricle thickness. These patients, like our own, has no family history of aortic valve stenosis, mitral valve prolapse, or HCM. However, this patient’s use of hydroxychloroquine to treat her SLE can be assumed to be a contributing factor to her HCM. This could suggest possible screening with ECG and TTE in patients taking hydroxychloroquine.
Abstract 17089: In Hospital Cardiovascular Outcomes of Patients With End Stage Renal Disease and Septic Shock a Propensity Matched Analysis
Authors: Braimah Olubumi A , Challa Abhiram , Vindhyal Mohinder Reddy , Ablah Elizabeth
Published: December 2023

Background:
Sepsis affects approximately 1.7 million adults in the US every year, and progression to septic shock (SS) leads to an increase in cardiovascular disease (CVD) and a 26% increase in mortality. Patients with end stage renal disease (ESRD) on dialysis are at an increased risk of developing SS and CVD. The increase in mortality with SS is well established in the literature, however, there is limited data determining the impact of ESRD on SS. This study aims to identify the impact of ESRD on in-hospital mortality and CVD outcomes among patients with SS.

Methods:
The 2020 National Readmissions Database was analyzed. Patients with SS and ESRD were identified using relevant ICD-10 codes. Nearest propensity matching was conducted using a 1:1 ratio for several demographic, social and clinical variables. Subsequently, in-hospital outcomes were compared between patients with and without ESRD using t-test and chi-squared test as appropriate.

Results:
A total of 822,321 patients were included in this study, with a mean age of 65 years. Majority of patients in this study with and without ESRD respectively were male (54.39% and 50.83%, p <0.001). In- hospital mortality for patients with SS, with and without ESRD, were 38.68% and 30.01%, respectively. Among patients with SS, mortality with and without ESRD was 38.36% and 30.01% (p < 0.001) respectively. Other significant cardiovascular events among patients with and without ESRD, respectively were ischemic stroke (3.82% vs. 3.28%, p <0.001), atrial fibrillation (11.85% vs. 10.2%, p <0.001), Endocarditis (4.06% vs. 2.24%, p <0.001), and acute diastolic heart failure (10.17% vs. 9.41%, p =0.001).

Conclusions:
SS in patients with ESRD is associated with an increased frequency of in-hospital mortality and worse cardiovascular outcomes when compared to patients without ESRD. Further research is needed to help establish and identify the causative factors in determining the association between SS and ESRD.
Abstract 17120: ARO-ANG3, an Investigational RNAi Therapeutic, Silences the Expression of ANGPTL3 and Decreases Atherogenic Lipoproteins in Patients With Mixed Dyslipidemia: ARCHES-2 Study Results
Authors: Watts Gerald F , Gaudet Daniel , ALTAMIRANO DARIO , Hegele Robert , Ballantyne Christie M , Nicholls Stephen , Chang Ting , Alagarsamy Sudar , Fu Ran , San Martin Javier , Rosenson Robert S
Published: December 2023

Background:
Angiopoietin-like protein 3 (ANGPTL3) regulates lipoprotein metabolism by inhibiting lipoprotein and endothelial lipases.
ANGPTL3
loss-of-function carriers have decreased circulating triglycerides (TGs), LDL-C, and HDL-C, and a lower risk of atherosclerotic cardiovascular disease (ASCVD). ARO-ANG3 is an investigational RNAi therapeutic designed to inhibit hepatic
ANGPTL3
expression and reduce atherogenic lipoproteins.

Aim:
We report end-of-study results (data cutoff 09 December 2022) from ARCHES-2, a Phase 2b double-blind, placebo (pbo)-controlled study (NCT04832971) to evaluate the safety and efficacy of ARO-ANG3 in adults with mixed dyslipidemia (MD).

Methods:
Patients with fasting TGs 150-499 mg/dL and LDL-C ≥70 mg/dL or non-HDL-C ≥100 mg/dL were randomized to receive 50 mg, 100 mg or 200 mg ARO-ANG3 or pbo by subcutaneous injections on Day 1 and Week 12. Patients were on a stable diet and optimal lipid-lowering therapies. The primary endpoint was the percent change in TGs from baseline at Week 24. Liver fat was assessed at baseline and Week 24 in a subset of patients with hepatic steatosis. Mixed models repeated measures was used for statistical analyses.

Results:
At Week 24, ARO-ANG3 decreased ANGPTL3 (up to 77%), TGs (up to 56%), remnant cholesterol (up to 56%), and apolipoprotein B (apoB) (up to 20%). Other lipoproteins including LDL-C, non-HDL-C, lipoprotein(a) and HDL-C were also decreased. Liver fat decreased similarly in ARO-ANG3 and pbo groups. TEAEs were consistent with those expected in this patient population and with associated underlying comorbidities.

Conclusions:
ARCHES-2 data demonstrate ARO-ANG3 efficacy by significantly lowering ANGPTL3 and atherogenic triglyceride-rich lipoproteins (TRLs), LDL and total apoB in patients with MD. The favorable changes in serum lipids and lipoproteins and safety profile support the potential of ARO-ANG3 to treat residual ASCVD risk in patients with elevated TRLs not at LDL-C goal.
Abstract 17128: Detection of Hypertrophic Cardiomyopathy From Noisy Single-Lead Electrocardiography
Authors: Khunte Akshay , Aminorroaya Arya , Dhingra Lovedeep S , Sangha Veer , Oikonomou Evangelos K , Sen Sounok , Krumholz Harlan M , Kramer Christopher M , Desai Milind Y , Khera Rohan
Published: December 2023

Background:
Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death among young people and be detected from ECGs using artificial intelligence. Wearable devices could allow for broad AI-based screening but obtain noisy ECGs. We report the development of a wearable-adapted AI-ECG model that retains performance for detecting HCM in noisy single-lead ECGs.

Methods:
In 11,883 ECGs obtained within 30 days of transthoracic echocardiograms from Yale New Haven Hospital (2015-2021), we defined HCM as interventricular septal wall thickness (end diastole) (IVSd) > 15 mm and moderate to severe left ventricular diastolic dysfunction (LVDD). Standard and noise-adapted models were trained using a 1:10 age-sex matched dataset. For the noise-adapted model, each ECG was included four times in the training set, augmented each time with random gaussian noise within four distinct frequency ranges emulating different real-world noise sources. We evaluated the performance of the noise-adapted and standard models on an independent set of ECGs with four different real-world noisy artifacts, including noise extracted from a portable device ECG, at multiple signal-to-noise ratios (SNRs).

Results:
In single-lead ECGs without noise, the noise-adapted model outperformed the standard model, with an AUROC of 0.920 and 0.906, respectively for HCM. With the same ECGs augmented with noise ranging from half (SNR 2) to twice (SNR 0.5) the signal, the noise-adapted model maintained their performance across real-world noise signatures (A). At an SNR of 0.5, the noise adapted model had a significantly greater performance in detecting HCM in ECGs augmented with portable device ECG noise (AUROC 0.917 [0.861-0.974] vs 0.609 [0.398, 0.821]) (B).

Conclusions:
We developed a model which accurately screens for HCM in noisy single-lead ECGs. This approach represents a more accessible and scalable method for screening for HCM using wearable device ECGs.
Abstract 17130: Metabolic and Epigenetic Coupled Regulation in Angiogenic Transdifferentiation and Vascular Recovery
Authors: Lai Li , Li Shuang , Lu Alexander J , Carter Kaylee , Nagueh Eric , Cooke John P
Published: December 2023

Recent studies from our group and others have characterized the phenomenon of "angiogenic transdifferentiation” from fibroblasts to endothelial cells as a novel endogenous mechanism for microvasculature expansion and perfusion restoration in murine models of hindlimb ischemia and myocardial infarction. Metabolic regulation of epigenetic reprogramming has emerged as a key regulatory process controlling cell fate transition. To study the comprehensive role of metabolism in this healing process, we conducted liquid chromatography-mass spectrometry (LC-MS) based untargeted and targeted metabolomics during transdifferentiation. Our analysis revealed the upregulation of key metabolites, including UDP-GlcNAc (substrate for post-translational modification O-GlcNAcylation) and acetyl-CoA (substrate for histone acetylation). With our
in vitro
transdifferentiation protocol, we found that pharmacologic or genetic inhibition of OGT (O-GlcNAc transferase, the enzyme responsible for protein O-GlcNAcylation) or ACL (ATP citrate lyase, the enzyme converting citrate to acetyl-CoA) in human BJ fibroblasts impairs transdifferentiation. Employing a preclinical peripheral arterial disease (PAD) hindlimb ischemia model with fibroblast lineage tracing mice, we discovered that O-GlcNAcylation and ACL were accumulated in fibroblast lineage cells in ischemic limbs, and pharmacologic inhibition of OGT or ACL diminished the transdifferentiation cell population in the ischemic tissue. Furthermore, we identified fibroblast-specific OGT or ACL KO impaired vascular recovery post femoral artery ligation in the mice. Finally, we showed that metabolism-dependent post-translational modifications on histones (acetylation of H3K9, H3K27, H3K14) or histone chaperons (O-GlcNAcylation of HIRA, a histone H3.3 chaperone) mechanistically enhanced chromatin openness, thereby facilitating cell fate plasticity and vascular regeneration. In conclusion, our studies demonstrate the significant regulatory potential of metabolic factors in angiogenic transdifferentiation which presents an innovative avenue to enhance vascular recovery in ischemic vascular diseases such as PAD.
Abstract 17154: Arrhythmias Associated With Acute Caffeine Toxicity
Authors: Teraoka Justin T , Tang Janet J , Noubiap Jean Jacques , Dewland Thomas A , Marcus Gregory M
Published: December 2023

Introduction:
Recent evidence has failed to demonstrate an association between caffeine consumption and arrhythmias. However, case reports have suggested an increased risk of arrhythmias associated with excessive caffeine intake. This relationship has yet to be studied in a large population.

Goals:
To describe the frequency and types of arrhythmias associated with caffeine toxicity.

Methods:
We used Emergency Department (ED) data from the California Department of Health Care Access and Information to identify California residents aged ≥ 18 years between January 1, 2005 to December 31, 2020. Caffeine toxicity and arrhythmias were identified using ICD9/10 codes. Multivariable logistic regression models were used to compare the frequency of arrhythmias between those with caffeine toxicity to those visiting the ED for any other reason.

Results:
Among 23,755,762 patients, 725 (< 0.01%) had caffeine toxicity. Those with caffeine toxicity were younger (mean 28.9 ± 12.1 years), male (67.0%), of lower income, and had less cardiovascular comorbidities. Of these, 4 (0.6%) had atrial fibrillation, 3 (0.4%) supraventricular tachycardia, 2 (0.3%) premature ventricular contractions, 1 (0.1%) cardiac arrest, and 7 (1.0%) unspecified arrhythmias. No one with caffeine toxicity had premature atrial contractions, ventricular tachycardia or fibrillation. Before adjustment, caffeine toxicity was 1.7 times more likely to be associated with an arrhythmia (odds ratio [OR] 1.70, 95% confidence interval [CI] 1.05 to 2.75). After adjustment, caffeine toxicity was 7 times more likely to be associated with an arrhythmia (OR 6.81, 95% CI 4.13 to 11.24) (
Figure
).

Conclusions:
Caffeine toxicity was strongly associated with both atrial and ventricular arrhythmias. While recent studies found no increased risk of arrhythmias associated with regular caffeine consumption, these data suggest that excessive caffeine intake may yet heighten the likelihood an arrhythmia may occur.
Abstract 17163: The Relationship Between TIMI Frame Count, Microvascular Resistance, and Coronary Flow Reserve in Patients With Ischemia and Nonobstructive Coronary Arteries
Authors: Loftspring Ethan , Harkin Kenneth , Joa Amanda , Serrano-Gomez Claudia , Farid Ayman , Reynolds Harmony , Smilowitz Nathaniel R
Published: December 2023

Introduction:
Ischemia and nonobstructive coronary artery disease (INOCA) may be caused by coronary microvascular dysfunction (CMD), but coronary function testing for CMD is not routinely performed. Consensus statements include coronary flow reserve (CFR), an index of microcirculatory resistance (IMR), or coronary slow flow by corrected TIMI frame count (cTFC) >25 as diagnostic for CMD. However, correlations between cTFC and invasive parameters of CMD are uncertain.

Methods:
Adults age ≥ 18 with INOCA (<50% stenosis by invasive coronary angiography in all major epicardial coronary arteries) were prospectively enrolled. cTFC was measured from baseline angiography of the left anterior descending artery. Invasive coronary function testing using thermodilution techniques was performed to identify CMD, defined by IMR≥25 and/or CFR<2.5. Relationships between cTFC and invasively derived CMD were evaluated.

Results:
Ninety-seven patients (mean age 60.4 ± 11 years; 80% female) underwent assessment; coronary slow flow was present in 46%. Coronary slow flow (cTFC>25) had a sensitivity of 50%, a specificity of 57%, a positive predictive value of 53%, and a negative predictive value of 54% to identify CMD defined by IMR and/or CFR. cTFC weakly correlated with IMR (r=0.40, p<0.001) and was not correlated with CFR (Pearson r=-0.03, p=0.73). Areas under the receiver operating characteristic curves were calculated for cTFC to identify abnormal IMR (AUC = 0.64), CFR (AUC = 0.55), CMD (AUC = 0.59), and CMD endotypes of abnormal IMR with normal CFR (AUC = 0.65), abnormal CFR with normal IMR (AUC = 0.58), abnormal IMR and CFR (AUC = 0.54).

Conclusions:
Coronary slow flow by angiography was not a reliable indicator of CMD defined by abnormal IMR and/or CFR. Correlations between cTFC and IMR were poor and no correlation with CFR was observed. These findings raise questions regarding the relevance of coronary slow flow at baseline to assess microvascular pathology causing INOCA.
Abstract 17177: Safety and Efficacy of Direct Oral Anticoagulants in Comparison to Warfarin in Obese Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis
Authors: Adelkhanova Alla , Oli Prakash Raj , Jha Vivek , Shrestha Dhan B , Shtembari Jurgen , Shantha Ghanshyam
Published: December 2023

Introduction:
Obesity affects nearly 650 million adults worldwide and the prevalence of obesity has been steadily increasing. Obesity has adverse effects on cardiovascular health, increasing the risk for developing hypertension, coronary artery disease, heart failure and atrial fibrillation (AF). It is well known that anticoagulation is warranted in patients with AF, however the safety and efficacy of direct oral anti-coagulant (DOAC) over vitamin K antagonist (VKA) are not well explored in the obese population. This meta-analysis aimed to compare DOAC to VKA in obese populations with AF.

Methods:
The PRISMA guidelines were followed for this meta-analysis, and it was registered in PROSPERO (CRD42023392711). PubMed, Medline, Embase, Cochrane Library and Scopus databases were searched for relevant articles from inception through January 2023. Two independent authors screened title and abstract, followed by full text review in Covidence. Data were extracted in Microsoft Excel and analyzed using RevMan v5.4 using odds ratio as effect measure.

Results:
2259 studies were identified from the database search and 19 studies were included in the analysis. There were significantly lesser odds of ischemic (OR 0.71, 95% CI 0.66-0.75) and hemorrhagic stroke (OR 0.47, 95% CI 0.35-0.62) in the DOAC group compared to VKA group. There were also lower odds for occurrence of systemic embolism (OR 0.67, 95% CI 0.54-0.83) and major bleeding (OR 0.62, 95% CI 0.54-0.72) in the DOAC group.

Conclusions:
Based on this meta-analysis it can be concluded that DOACs are safer and more efficacious than vitamin K antagonists in the obese population with AF.
Abstract 17178: Rates of Micro Embolic Signals at Different Stages of Carotid Artery Revascularization
Authors: Wiley Karlo A , Anker Allison , Sanina Cristina , Kozdag Gold Guliz
Published: December 2023

Background:
The American Heart Association currently estimates that over 160,000 people die every year due to new or recurrent strokes, many from carotid artery stenosis. This association has led to increased use of carotid revascularization procedures such as carotid endarterectomy (CEA) and carotid artery stenting (CAS). In this study we aim to describe the different rates of micro embolic signals (MES) at different stages of carotid artery revascularization.

Methods:
Before elective carotid revascularization 57 patients (mean age 72±8 years; 15 males, 21 females) underwent 3-T MRI. After localization of the carotid bifurcation using phase contrast imaging, Time-of-Flight, 3D T1 weighting, transverse T1 and T2 weightings and proton density sequences were acquired. The different plaque components: lipid core, intraplaque hemorrhage, calcification and the characterization of the fibrous cap were assessed. While 34 patients underwent CEA, 20 patients had CAS. CES was divided into 9 stages: 1- Pre-procedure, 2- Dissection, 3- IC clamp, 4- Shunt placement, 5- Shunt open, 6- Endarterectomy, 7- Clamped, 8- IC opened, 9- Post-procedure. Similarly, CAS was divided into 9 stages: 1- Pre-procedure, 2- Arch-carotid angiography, 3- Wire insertion, 4- Filter deployment, 5- Pre-dilation, 6- Stent deployment, 7- Post-dilation, 8- Final angiography, 9- Post-procedure. Patients were monitored continuously with transcranial doppler (TCD) to detect pre-procedural, intra-procedural and post-procedural MES rates.

Results:
MES was detected in 20 (87%) patients undergoing CAS compared to 18 (53%) patients undergoing CES during the IC Clamp/Wire Insertion stage (p=0.004). Greater mean micro embolic signals were also found in symptomatic patients undergoing CAS than in asymptomatic patients during arch-carotid angiography (10.8 vs 2.4, p= 0.022), post-dilation (3.1 vs 1.1, p=0.047), and post-procedure (4.8 vs 1.3, p=0.044).

Conclusion:
MES is increased during the wire insertion stage of CAS in addition to post-dilation and post-procedure stages. Also, the finding of increased MES during arch-carotid angiography suggests that less invasive alternatives to diagnostic angiography should be considered in symptomatic patients.
Abstract 17213: Machine Learning-Based Prediction of Type A Aortic Dissection
Authors: Velasco Juan , Zafar Mohammad , Elefteriades John A
Published: December 2023

Background:
Existing risk predictors of aortic dissection have certain limitations. We hypothesized that machine learning models trained on clinical, demographic, and anthropometric features can further improve the prediction of patient outcomes.
Objective:
This study aims to develop a machine learning model that predicts type A aortic dissection and can help clinical decision making.

Methods:
This cohort study used the Yale Aortic Institute database. The models incorporated variables spanning demographic, anthropometric, medical history, radiological, and laboratory domains. The models were trained and validated using stratified 10-fold cross-validation. Hyperparameters for each algorithm were tuned through grid-search on the training folds. The models were trained to optimize the area under the receiver operator characteristic curve (AUROC) and were assessed in a held-out test set.

Results:
A total of 2,109 patients were analyzed in our study. Among them, 271 were diagnosed with type A aortic dissection. The models demonstrated strong performance on the held-out test set. Specifically, the extreme gradient boosting decision tree model achieved an AUROC of 0.821, while the random forest model achieved an AUROC of 0.820. Importantly, these models outperformed the prediction of type A aortic dissection when based solely on the ascending aorta diameter, which had an AUROC of 0.549. Besides the ascending aorta diameter, the key predictors were age, weight, height, family history, smoking, bicuspid aortic valve, and hypertension.

Conclusion:
We developed a machine learning model that provides an individualized prediction of the development of type A aortic dissection. This approach provides an accessible, efficient, and remote tool to identify high-risk patients.
Abstract 17226: Role of
BMPR2
Mutation in the Development of RV Failure in Rat Experimental Pulmonary Hypertension
Authors: Ohya Kazunobu , Sawada Hirofumi , Mitani Yoshihide , TSUBOYA NAOKI , Takeoka Mami , Yodoya Noriko , Ohashi Hiroyuki , Ito Hiromasa , Okamoto Ryuji , Dohi Kaoru , Mashimo Tomoji , Maruyama Kazuo , Hirayama Masahiro
Published: December 2023

Introduction:
BMPR2
mutations are the major genetic risk factor for pulmonary arterial hypertension (PAH) and are associated with increased disease severity and worse survival. Although worsening disease severity and prognosis in
BMPR2
mutation carriers has been explained by more severe pulmonary vascular disease (PVD), recent reports suggest that
BMPR2
mutations affect right ventricular (RV) myocardium and its function independently of PAH. However, mechanism of dysfunctional RV in
BMPR2
mutations carriers are unknown.[Hypothesis]Rats with
Bmpr2
mutation have impaired RV function independently of PVD compared to wild-type (WT) rats.

Methods:
Bmpr2
mutant rats were generated by CRISPR/Cas9 genome editing. Monocrotaline (MCT)-PH model was generated in mutant rats and WT littermates and changes in RV function over time with disease progression were assessed by echocardiography and catheterization in rats with (n=23) or without tadalafil treatment (n=88)

Results:
In untreated setting, there were no significant differences in RV systolic pressure (RVSP) and RV function between the two groups on 21 days after MCT, whereas RV-fractional area change (FAC) and cardiac index (CI), assessed at later disease stage (23 to 25 days), were significantly lower in
Bmpr2
mutant rats than in WT (RV-FAC: WT 41.0±8.3 vs
Bmpr2
mutant 27.5±11.5%, p<.0001; CI: 413.2±114.0 vs 263.0±92.9ml/min/kg, p<.0001) at comparable RVSP (64.5±11.6 vs 66.7±8.0mmHg) but higher total pulmonary resistance index (TPRI: 0.16±0.06 vs 0.27±0.09mmHg/ml/min/kg, p<.0001). In rats with tadalafil treatment,
Bmpr2
mutant rats had significantly lower RV-FAC (34.4±8.2 vs 23.6±5.4%, p<.05) and more severe RV myocardial fibrosis compared to WT littermates despite no significant differences in RVSP (75.4±8.7 vs 71.0±8.2mmHg) and TPRI (0.19±0.06 vs 0.22±0.08mmHg/ml/min/kg) on 30 days after MCT.

Conclusion:
In untreated setting, RV dysfunction in
Bmpr2
mutant was associated with increased afterload due to exacerbation of vascular lesions; rats treated with PDE5i and with prolonged survival had reduced RV function at comparable afterload, indicating the importance of managing RV function under treatment of PAH.
Abstract 17229: Atrioventricular Conduction System Changes During Transcatheter Aortic Valve Replacement (TAVR)
Authors: Clarke John-Ross D , Rathakrishnan Bharath , Poulin Marie-France , Laham Roger J , Ultimo Beattie , Guibone Kim , Pinto Duane S , Kiernan Katherine , Medline Alexandra , Haouzi Alice , Omar Wally , Tuttle Mark , Hardy Tyler , Waks Jonathan W , Buxton Alfred E
Published: December 2023

Introduction:
Transcatheter aortic valve replacement (TAVR) is complicated by atrioventricular (AV) conduction disturbance in 8-15% of cases. Prior studies have not utilized complete electrophysiology studies (EPS) with continuous recording during TAVR. We sought to better understand the potential utility of intraprocedural electrophysiologic study to identify patients at risk for developing high-grade AV conduction disturbances after TAVR.

Hypothesis:
Intraprocedural EPS has the potential to identify patients at risk of developing AV conduction block after TAVR.

Methods:
We conducted a prospective study of TAVR patients at BIDMC between 5/2021-3/2023, excluding those with pre-existing pacemakers/defibrillators. We performed EPS in the cath lab prior to and after valve replacement: atrial pacing to AV block, recording His bundle electrogram (HBE) and RV pacing to assess VA conduction. When possible we recorded the HBE continuously during valve implant.

Results:
We studied 400 consecutive patients. Forty-three patients (10.8%) received permanent pacemakers (PPMs). Patients receiving PPM had significantly longer post-HV intervals, greater change in HV interval as well as longer AV Wenckebach cycle length after valve replacement. There were no differences in pre-TAVR AV Wenckebach cycle length or VA conduction. Twenty patients (46.5% of all PPMs) were implanted for AV block post discharge, and after adjustment for age, gender, and baseline HV interval, the only predictor of need for post-discharge PPM was peri-TAVR change in HV interval with an adjusted OR of 1.19 per each 10 ms increase.

Conclusions:
In contrast to prior studies, we have found that EPS at the time of TAVR may have utility in predicting AV conduction disturbances. Larger increases in HV interval and AV block CL were associated with need for PPM. Measuring the peri-TAVR change in HV interval may be useful in predicting late AV block.
Abstract 17237: Trends in Sex and Regional Disparities Among Authorships in American Heart Association Scientific Sessions (2019-2023): A Bibliometric Analysis
Authors: Perera Ayodya , Mondal Avilash , LAPSIWALA BONEY , Mendpara Vaidehi , Nair Amritha , Kodali Athri , Gurumoorthy Rohini Bhuvaneshwari , Chenna Venkata Balaji , Rajpopat Pratik Bharat , Iermolenko Valeriia , Desai Brinda , Gnanaguruparan Subramanian , Desai Rupak
Published: December 2023

Background:
Women continue to be underrepresented in clinical medicine, including cardiology, despite improvements in participation. We aim to examine gender and regional disparities in authorship of abstracts published in AHA scientific sessions.

Method:
AHA journal was screened for abstracts with keywords: "Meta-analysis", "Systematic Review" or "Pooled analysis from 2019-2023. 499 out of 567 studies were included from circulation journal of AHA, and data on gender of first and corresponding (last) author was extracted with a validated smartdata application from 7.5 billion people's names (namsor.app). Abstract category and regions of affiliation data were extracted. Chi-square was used to describe trends.

Results:
Of 499 abstracts (2019:21.4%, 2020:23.2%, 2021:20.2%, 2022:31.9%, 2023:3.2%) females as first author were 24% and as last author was 18.8%. Categories of abstracts were general cardiology (GC)(32.7%), interventional cardiology (IC)(24.8%), electrophysiology (EP)(12.4%), and cardio-oncology (CO)(2.6%). North America (NA) had the highest number of abstracts (67.5%). Meta-analyses were higher than systematic reviews (88.6% vs. 10.6%), pooled analyses were higher than comparison plots (51.1% vs 41.3%, p =0.001). Male corresponding and first author (62.2%) were higher than inter-sex corresponding and first authors. Yet, corresponding male authors with female first was higher than female corresponding with male first (16.4% vs 11.5%) and corresponding female authors with female first was lower than male first (11.5% vs. 9.9%, p=0.015). Disparity is noted in abstract categories across regions. IC was more in Asia (23.5% vs. 21.6) compared to GC, while GC was more common in Europe (48.5% vs. 24.2%) and NA (32.7% vs 23.2%).

Conclusion:
Gender disparity was noted across abstract categories and regions. Women need to be represented more in clinical and academic research. Further studies are needed to identify barriers to equal representation.
Abstract 17246: Using Alerts vs Automated Tools to Better Document CHADS2-VASc Scores in Patients Hospitalized With Atrial Fibrillation
Authors: Klarr Daniel , Tabit Corey E , Cerasale Matthew
Published: December 2023

Introduction:
Atrial fibrillation (Afib) is the most common cardiac arrhythmia in the United States and a significant burden on our healthcare system. Currently as many as six million people in the United States carry a diagnosis of Afib, with that number likely increasing as our population ages and our methods of detection improve. Accurate diagnosis and risk stratification are imperative as these patients may have stroke rates as high as 20% annually. Comprehensive documentation of the CHADS2-VASc score can better determine the need for Anticoagulation for patients hospitalized with Afib

Hypothesis:
What is the rate of recording of CHADS2-VASc scores in patients admitted to House Staff and Hospitalist teams and what interventions would lead to better data gathering: a best practice alert or an automated diagnosis tool in the Electronic Medical Record (EMR).

Methods:
At The University of Chicago Medical Center, attendings on the cardiology service and hospitalists documented CHADS2-VASc without intervention. Then the response rate was measured after implementing a best practice alert, or soft stop dialog box in the EMR. Later for Hospital Medicine teams, an auto diagnosis tool, a hard stop auto-generated in the note, was added to the EMR.

Results:
Over the course of three years (January 2018 to December 2021) CHADS2-VASc score was charted an average of 1% of the time for hospitalists and 7% of the time for House Staff Cardiology. After implementing the EMR Best practice alert (January 2022 to January 2023 for House Staff and January 2022 to November 2022 for Hospitalists) these rates increased to 19% (p <0.0001) for the hospitalist team and 54% for the House Staff Cardiology team (p<0.00001). With the Auto diagnosis tool (November 2022 to January 2023) the rate increased from 19% to 56% (p <1x10
-7
)

Conclusions:
As our data shows, CHADS2-VASc scores recording rates remained low among both cardiology and medicine attendings. However, an EMR generated alert increased responses while an auto diagnosis tool increased documentation even more. This demonstrates the effectiveness of EMR tools. This improvement in adherence should also lead to better rates of prescribing Anticoagulation to patients with higher risk.
Abstract 17255: Local Gunfire Exposure is Associated With Acutely Increased Blood Pressure on the South Side of Chicago
Authors: Obaoye Joanna O , Zhou Yu , Chua Rhys F , Agha Al Kola Mustafa , Tabit Corey E
Published: December 2023

Hypertension is a leading risk factor for cardiovascular disease, which is especially prevalent among minority urban patients. Our group and others have previously shown that socio-environmental factors such as crime and poverty raise cardiovascular risk. However, the acute effects of local urban gunfire on patients’ blood pressure are unknown. We hypothesized that local gunfire in our South Side Chicago community was temporally associated with an acute rise in blood pressure for nearby patients. We performed a retrospective cohort study including 7,564 patients aged 18-104 who completed two or more outpatient clinic visits within 1 year at our academic tertiary-care center on the South Side of Chicago. We included 41,554 pre-pandemic clinic visits and recorded the blood pressure for each visit. Local gunfire was measured using ShotSpotter®, a network of microphones installed throughout the South Side of Chicago, which locates gunshots using auditory triangulation. Datasets of gunfire incidents are publically available from ShotSpotter® including date/time and geolocation of incidents. We focused on incidents that occurred within 1 km of each patient’s address and between two clinic visit dates (33 days, on average). Our primary outcome was the change in systolic blood pressure between the two clinic appointments. We excluded patients whose antihypertensive regimen was changed at the first appointment. Next, we utilized a multivariate regression model to assess the relationship between incidents of gunfire and seasonally-adjusted changes in blood pressure. Between-visit gunshot exposure ranged from 1 to 1,793 per patient. We found that each incident of gunfire was associated with a statistically significant acute increase in systolic blood pressure (0.0033 mmHg increase per gunfire incident [0.0022, 0.0044], p<0.0001). Results were similar regardless of whether total round count or total gunfire incidents were considered. In this study of urban patients, incidence of gunfire within 1 km of a patient’s address was associated with an acute rise in blood pressure over approximately 1 month. These findings implicate the adverse impact of local gunfire exposure and environmental stress on blood pressure in adults on the South Side of Chicago.
Abstract 17301: C-Reactive Protein and Long-Term Risk of Death in Patients With Myocardial Infarction
Authors: Borchsenius Julie , Kragholm Kristian , Bødtker Mortensen Martin , Egeberg Alexander , Polcwiartek Christoffer , Vesterlev Ditte , Torp-Pedersen Christian , Biering-Srensen Tor , Pareek Manan
Published: December 2023

Introduction:
The long-term prognostic value of C-reactive protein (CRP) in patients with myocardial infarction (MI) is unknown.

Purpose:
To assess the association between the first CRP measured during hospitalization and long-term mortality in patients with MI.

Methods:
Using Danish nationwide registries, we identified patients with a first diagnosis of MI from 2012 through 2020 who underwent a CRP measurement during index hospitalization. The primary outcome was death from any cause. The association between CRP levels and death was examined stratifying the patients into quartiles of CRP concentrations. Absolute and relative risks (RR) for death at days 0-30 and 31-365 were calculated through multivariable Cox regression with average treatment effect modeling. Models were standardized for demographic and clinical features, including high-sensitivity troponin (hsTn).

Results:
We included 36,021 patients with MI and a CRP measurement within 24 hours before or after the time of admission. Median age was 69.7 years and 35.2 % were women. Median CRP in the entire cohort was 4.9 mg/l, and quartile (Q) intervals were: Q1: <3 mg/l, Q2: 3 to <5 mg/l, Q3: 5 to <17 mg/l, and Q4: >=17 mg/l. CRP was significantly and nonlinearly associated with the primary outcome (p<0.001). At 0-30 days, 2694 patients had died, and another 2566 had died between days 31-365. Figure 1 shows the Kaplan Meier curves. The standardized absolute risk of death at both 0-30 and 31-365 days was lowest among patients in Q1 (0-30 days: 4.1%, 31-365 days: 4.8%) and highest among patients in Q4 (0-30 days: 12.1%, 31-365 days: 10.6%). The standardized RR of death compared with Q1 were: 0-30 days 1.01 (95% CI 0.84;1.71), 1.45 (1.26;1.63) and 2.96 (2.61;3.29) in Q2, Q3 and Q4 and at days 31-365, the RR were 1.18 (1.02;1.34), 1.61 (1.42;1.79) and 2.19 (1.95;2.42), respectively.

Conclusion:
In patients with MI, higher CRP levels were significantly associated with a higher risk of death, independently of hsTn concentrations.