bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14648: Can GRACE Risk Score Predict Mortality in Pulmonary Embolism?
Authors: donmez esra , Ozcan Sevgi , Ziyrek Murat , Sahin Irfan , Okuyan Ertugrul
Published: June 2023

Introduction
Risk stratifying of pulmonary embolism (PE) patients and treatment for normotensive patients is still challenging. We aimed to assess the utility of GRACE risk score for 30-day mortality.

Methods
All consecutive patients hospitalized with a diagnosis of PE between2016 -2021 were included in this retrospective study. GRACE and PESI scores were calculated online.

Results
A total of 197 patients were enrolled. Mean age was 63.98±15.51. 56 of patients died by the end of the 30-day. When patients divided into 2 groups according to 30-day mortality, both groups were similar in terms of gender, hypertension, diabetes mellitus, coronary artery disease, heart failure and chronic obstructive pulmonary disease. Troponin level (212.4± 24.6 vs. 850.8±231.1; p<0.0001), PESI (122.3±27.2 vs. 170.1±49.1; p<0.0001) and GRACE (127.1±28.8 vs. 182±21.3; p<0.0001) were significantly higher in non-survivor group. The correlation analysis we observed strong positive correlation between PESİ and GRACE (r=0.732; p<0.0001). Regression analysis revealed that only GRACE score [p=0.021, β: 1.146, OR (95% CI): 1.021-1.286] was an independent risk factor associated with 30-day mortality. ROC curve for accuracy of GRACE score for predicting 30-day mortality in PE patients is shown in figure 1. Area under curve (AUC) for GRACE score was 0.969 [%95 CI: 0.948-0.990]. A cut off value of 161.5 for GRACE score was associated with 90.0% sensitivity and 89.7% specificity in prediction of 30-day mortality.
Conclusion
In this study, the relation between GRACE score and the clinical course of PE patients evaluated and we found GRACE risk score as an independent risk factor associated with 30-day mortality and strong correlation between GRACE and PESİ risk scores. To predict the mortality of high-risk normotensive and hypotensive PE patients,GRACE risk score exhibited high specificity and positive probability.
Abstract 14711: Radial Artery Patency Following Distal Transradial Access in Patients With Advanced Chronic Kidney Disease
Authors: Mosarla Ramya C , Ahmed Hamza , Rao Shaline , Kadosh Bernard , Cruz Jennifer , Goldberg Randal , Saraon Tajinderpal , Gelb Bruce , Mattoo Aprajita , Rao Sunil V , Bangalore Sripal
Published: June 2023

Background

Radial artery occlusion (RAO) with transradial access is reported in 6-9% of patients with advanced chronic kidney disease (CKD) and may preclude the creation of an arteriovenous fistula for dialysis. Distal transradial access (dTRA) has lower rates of RAO compared with proximal transradial access but studies excluded patients with advanced CKD.

Methods:
We sought to define procedure characteristics and RAO rates with dTRA in CKD. Patients who underwent cardiac catheterization with dTRA from 01/01/2019 to 01/01/2022 with follow-up of radial artery patency by reverse Barbeau or repeat access of the artery were included.

Results:
A total of 68 patients with a median age of 60 (IQR 54-69), 50 (74%) males were included. A total of 44 (65%) were on hemodialysis. Of the procedures, 59 (87%) were diagnostic and 9 (13%) were PCIs. Access was ultrasound guided, a majority (79%) were right dTRA and all had spasmolytic therapy and patent hemostasis. Sheaths were 5 French short (7 cm) in 40 (59%) and 6 French short in 28 (41%). Mean contrast volume was 20+/-11 ml for diagnostic procedures and 91+/-53 ml for PCIs. Mean radiation exposure was 290+/-156 mGy for diagnostic procedures and 1692+/-961 mGy for PCIs. Mean fluoro time was 5+/-4 mins for diagnostic procedures and 24+/-13 mins for PCIs
.
Of 9 patients with PCIs, mean number of stents was 2+/-1 and atherectomy was used in 2 (22%) PCIs. The median number of diagnostic catheters was 1(IQR 1-2) and median guides was 1(IQR 1-1) in PCIs. Radial arteries were patent in 68 (100%) at follow-up.
(Figure 1)

Conclusions:
Our cohort demonstrates safety of dTRA in patients with advanced CKD with high rates of radial artery patency.
Abstract 14830: Comparative Cost-Effectiveness of Cardioprotective Glucose-Lowering Therapies for Type 2 Diabetes in a Middle-Income Country: A Bayesian Network Model
Authors: Carvalho Luiz Sergio F , Nogueira Ana Claudia C , Antunes Joaquim B , Moura Filipe A , Luchiari Beatriz , Bonilha Isabella , Nadruz Wilson , Gaziano Michael , Gaziano Thomas , Sposito Andrei
Published: June 2023

Introduction:
Unprecedented economic and social burden has expanded with the steady increase in Type 2 Diabetes (T2D) prevalence, particularly in low- and middle-income countries.

Hypothesis:
We hypothesize that novel anti-diabetic therapies such as SGLT2i or GLP1-RA would figure as more cost-effective among T2D subjects.

Methods:
Electronic databases were searched between August and April 2021. Inclusion criteria were: randomized clinical trials with T2D; articles published in English; double-blind, phase 3 or 4 trials; ≥100 patients per arm; follow-up >24 weeks; and the pre-specified endpoints: death from any cause, major adverse cardiovascular events, and hospitalization for heart failure. Two prospective cohorts of T2D patients were used to feed the Markov Influence Diagram transition probabilities. Bayesian Networks and Markov Influence Diagram were used to estimate the incremental cost-effectiveness ratios (ICER) per disease-adjusted life years [DALYs] averted. The perspective of the Brazilian public health system was considered for costs and values were converted to international dollars (Int$).

Results:
We selected a total of 157 trials generating a sample size of 684,389 patient-years. Modeling was based on a primary and secondary prevention cohort of 851 and 1,337 patients, respectively. SGLT2i [HR:0.81 (95%CI: 0.69; 0.96)], GLP-1RA [HR:0.79 (95%CI: 0.67; 0.94)], and pioglitazone [HR:0.73 (95%CI: 0.59; 0.91)] reduced the relative risk of non-fatal cardiovascular events. In primary prevention, pioglitazone resulted in 0.2339 DALYs averted, with ICER of Int$7,082 (95%CI: 4,521; 10,770) per DALY averted, when compared to standard care. SGLT2i and GLP-1RA also increased the effectiveness (0.261 and 0.259 DALYs averted, respectively) but with higher ICERs [Int$12,061 (95%CI: 7,227; 18,121) and Int$29,119 (95% CI:23,811; 35,367) per DALY averted, respectively]. In secondary prevention, the three classes were cost-effective at a maximum willingness to pay threshold of Int$26,700. In both scenarios, however, pioglitazone had the highest probability of being cost-effective.

Conclusions:
In a middle-income country, pioglitazone presented a higher probability of being cost-effective followed by SGLT2i and then GLP-1RA.
Abstract 14870: Adrenomedullin in Patients With Out-of-Hospital Cardiac Arrest
Authors: Zelniker Thomas A , Schwall Dominik , Hamidi Fardin , Steinbach Simone , Scheller Pascal , Spaich Sebastian , Giannitsis Evangelos , Katus Hugo A , Frey Norbert , Preusch Michael R
Published: June 2023

Introduction:
Adrenomedullin (ADM) is a free circulating peptide that regulates endothelial barrier function and vascular tone. Here, we sought to study the relationship of adrenomedullin in combination with lactate and the risk of death in patients with out-of-hospital cardiac arrest (OHCA) of non-traumatic origin.

Methods:
Mid-regional pro-ADM (MR-proADM) concentrations were measured in OHCA patients after successful ROSC on admission. The outcome of interest was all-cause death. Patients were characterized by quartiles (Q) of MR-proADM and lactate concentrations. Cox models were adjusted for age, sex, shockable rhythm, bystander resuscitation, and baseline eGFR.

Results:
A total of 232 patients were included in the present study (28% women, 67 years, SAPS II score 80). In total, 132 patients (56.9%) died, and 24 patients had an unfavorable neurologic outcome (i.e., a CPC score of 3-4). The median MR-proADM and lactate levels were 1.4 nmol/L (IQR 0.8 to 2.8 nmol/L) and 4.8 mmol/L (IQR 2.8 to 7.4 mmol/L), respectively. MR-proADM concentrations correlated weakly with lactate levels (r=0.23, P<0.001). High (Q4) versus low (Q1-Q3) MR-proADM concentration was associated with an increased rate of death at 28 days (45.4% vs. 75.9%; P<0.001;
Fig A
). After multivariable adjustment (including baseline lactate levels), higher MR-proADM levels were significantly associated with an increased risk of death (Q4 vs. Q1-Q3: adjusted HR 1.84, 95% CI 1.21 to 2.77; adjusted HR for 1 unit increase in standardized biomarker 1.55, 95% CI 1.28 to 1.86). The combination of high MR-proADM and high lactate (Q4) concentration identified patients at particularly elevated risk (adjusted HR 3.99; 95% CI 1.67-9.56;
Fig B
).

Conclusions:
Higher MR-proADM concentration are associated with an increased risk of death in patients with OHCA of non-traumatic origin. The combination of high MR-proADM and high lactate levels identifies patients at distinctly elevated risk.
Abstract 15025: Bone Marrow Cells Transdifferentiate Into Heterogenous Populations of Endothelial Cells in the Heart
Authors: Shabani Parisa , Shockling Lindsay , Enrick Molly , Alghadeer Ammar , Kolz Chris , Ohanyan Vahagn A , Dong Feng , Zhang Ping , Shi Xin , Yin Liya , Chilian William M
Published: June 2023

Introduction:
A substantial number of studies in animal as well as human have shown contribution of bone marrow (BM) derived cells to postnatal angiogenesis in physiological and pathological conditions. Despite this information, questions remain regarding whether bone marrow-derived cells can become endothelial cells and engraft in blood vessels.

Methods:
To address this question, we generated chimeric rats containing BM from transgenic rat with the ubiquitin promoter driving GFP (GFP
+
BM) that was transplanted into a wild-type irradiated recipient. Chimeric rats were subjected to repetitive ischemia (RI, LAD occlusion) over a period of 17 days using a model in which the LAD is subjected to episodic ischemia to induce angiogenesis and collateral growth.

Results:
Measurements of myocardial blood flow (MBF) in the collateral-dependent region revealed a 3-fold increase in the ratio of collateral-dependent to normal zone MBF after 17 days. This increase in flow is due to collateral growth and angiogenesis in the ischemic region. Fluorescence microscopy in conjunction with immunostaining for rat endothelial cell antigen-1 showed the BM derived endothelial cells integrated into coronary blood vessels. We performed single cell RNAseq after sorting GFP
+
/propidium iodide
-
cells from hearts (enzymatic digestion) and bone marrow of control and RI rats. After quality filtering we had a total of 24103 cells. Clustering the cells identified 28 clusters. we annotated endothelial cell clusters based on the expression of endothelial cell markers. We had comparable proportion of endothelial cell populations in control and RI groups. Using canonical markers of different endothelial cell subtypes, we characterized arterial, venous, capillary, and lymphatic subpopulations within endothelial cell cluster. The endothelial cell population in the RI group had more angiogenic profile with higher expression of angiogenesis markers and vessel development pathways in gene ontology analysis.

Conclusions:
Taken together, our data suggest that BM cells can differentiate into endothelial cells in hearts, representing a heterogenous population of endothelial cells and contributing to vascular growth.
Abstract 15256: Treatment With Ketone Ester in Patients With Cardiogenic Shock Improves Cardiac Performance
Authors: Berg Hansen Kristoffer , Christensen Kristian Hylleberg , Gopalasingam Nigopan , Nielsen Roni , Møller Niels , Birkelund Thomas , christensen steffen , Wiggers Henrik
Published: June 2023

Introduction:
Cardiogenic shock is a life-threatening condition but no medical therapy has been documented to improve outcome. Recent evidence suggests that the ketone body 3-hydroxybutyrate (3-OHB) has favorable hemodynamic effects in patients with stable chronic heart failure. However, the hemodynamic effects of exogenous ketone supplements to patients with cardiogenic shock remains unknown.

Hypothesis:
In patients hospitalized with cardiogenic shock, acute treatment with a ketone ester has beneficial hemodynamic effects.

Methods:
In a randomized, double-blind, crossover study, we included 12 patients with cardiogenic shock who were treated with inotropes and/or vasopressors. In random order, patients received an enteral bolus of 500 mg/kg ketone ester (KetoneAid Inc.) and isocaloric, isovolemic placebo containing maltodextrin. Each study period lasted for three hours and was separated by a 3-hour washout period. The primary endpoint was change in cardiac output expressed as area under curve (AUC). Secondary endpoints were recorded at the end of each study period and included mixed venous saturation (SVO
2
), pulmonary capillary wedge pressure, and echocardiographic measures of contractile function.

Results:
The ketone ester increased circulating 3-OHB significantly vs. placebo (peak: 3.7±0.5 mmol/L vs. 0.3±0.1 mmol/L, AUC: 6.0±0.9 mmol/L x hour vs. 0.3±0.1 mmol/L x hour, all p<0.001). This was accompanied by an increase in cardiac output (5.1±0.3 L/min vs. 4.4±0.3 L/min, p=0.043; AUC of relative change: 61±22 L vs. 1±18 L, p=0.044), primarily due to a higher stroke volume (53±4 mL vs. 47±4 mL, p=0.048). Ketone ester increased SVO
2
vs. placebo (61±2% vs. 57±3%, p=0.035) whereas heart rate, mean arterial, pulmonary arterial, and pulmonary capillary wedge pressures did not differ between study periods. Ketone ester increased left ventricular ejection fraction (32±3% vs. 28±3%, p=0.005) and global longitudinal strain (-7.3±0.7% vs. -6.5±0.6%, p=0.01) as compared with placebo.

Conclusions:
Treatment with ketone ester has beneficial hemodynamic effects in patients with cardiogenic shock by increasing cardiac output and left ventricular function.
Abstract 15266: Effect of Nicotine Exposure to Induced Pluripotent Stem Cell Derived Endothelial Cell Therapy in a Murine Model of Peripheral Artery Disease
Authors: Chan Alex Ho Pang H , Hu Caroline , Huang Ngan F
Published: June 2023

Introduction:
Clinical solutions for peripheral artery disease (PAD) remain elusive due to the many challenges of surgical intervention. Stem cell therapy offer a promising option, but barriers exist to their clinical translatability. Among these include lifestyle choices like tobacco use that may influence the efficacy of stem cell therapy. The objective of this study aims to examine the potential effects of nicotine on human induced pluripotent stem cell derived endothelial cells (iPSC-ECs) therapy in the context of PAD.

Hypothesis:
Chronic nicotine exposure negatively affects the therapeutic potential of implanted iPSC-ECs in a murine model of PAD.

Methods:
Mice were implanted with an osmotic pump for controlled exposed to nicotine or saline (control) for 28 days. Plasma cotinine was measured to confirm nicotine exposure. After 28 days of nicotine or saline exposure, the mice underwent induction of hindlimb ischemia and before receiving an injection of 10
6
iPSC-ECs. A second dose of cells were injected to the ischemic limb on day 7 post-surgery. All mice were monitored for blood perfusion recovery using laser Doppler spectroscopy imaging. Survival of the transplanted cells in vivo were tracked by bioluminescence imaging. The mice receiving iPSC-ECs were also imaged for cell survival using bioluminescence imaging. At day 14 post-surgery, mice were euthanized, and the gastrocnemius muscle and thigh muscle were harvested for histological analysis.

Results:
The average cotinine concentration in sera was ~200 ng/mL, which is within physiological range for a tobacco user. Blood perfusion recovery at day 14 showed trends of nicotine treated groups have hindered perfusion recovery, compared to those treated with saline. Importantly, nicotine exposure trended with poorer perfusion recovery after cell therapy. Bioluminescent imaging showed iPSC-ECs persisted in vivo for all groups without significant difference.

Conclusions:
Nicotine exposure was associated with poorer blood perfusion recovery after iPSC-EC therapy, compared to control saline exposure, suggesting that nicotine may have adverse effects on iPSC-EC therapy for treatment of PAD.
Abstract 15269: Late Recovery of Left Ventricular Function After Surgical Aortic Valve Replacement for Severe Aortic Regurgitation
Authors: Htay Yan Naung , Aung Su Sandi , Gopalakrishnan Prabhakaran , Koene Ryan
Published: June 2023

Introduction:
Surgical aortic valve replacement (SAVR) is recommended in symptomatic severe aortic regurgitation (AR) or asymptomatic severe AR with reduced left ventricular (LV) ejection fraction (LVEF). Although most patients have improvement in LV dimensions and LVEF early (< 6 months) after SAVR, severe baseline LV enlargement and reduced LVEF, along with persistent LV dilation after SAVR, carries a worse prognosis. We present a case in which a patient with these features had complete recovery of LVEF late (> 9 months) after SAVR for severe AR.

Case Description:
A healthy 62-year-old male presented with dyspnea and chest pain. Cardiac workup was significant for ECG showing left bundle branch block; both transthoracic and trans-esophageal echocardiograms showed bicuspid aortic valve with severe AR (Eccentric jet, pressure half time (PHT): 221 msec, jet width > 60% of LV outﬂow tract diameter), severely reduced LVEF 20-25%, and severe LV dilation (LVESD of 75 mm), and cardiac catheterization showed mild coronary disease. SAVR was performed without complications and heart failure therapy initiated. Patient declined cardiac resynchronization therapy. The LVEF and LVESD were persistently abnormal in TTE at 5 and 9 months. The TTE at 21 months showed normalization, with LVEF of 55% and LVESD of 46 mm, despite no prior improvement (Figure).

Discussion:
In severe AR following SAVR, volume overload reduction results in LV size reduction and improved LVEF, usually within a few months and in those with smaller baseline LV dimensions. Some studies suggest a specific LV dimension to perform SAVR. This report indicates that SAVR should not be excluded based on severe LV dilation alone.

Conclusion:
The incidence and mechanisms of delayed reverse cardiac remodeling in severe AR after SAVR and optimal timing of decision about device placement needs further investigation.
Abstract 15439: Longitudinal Assessment of Racial Differences in Exercise Capacity After Breast Cancer Treatment: WF-97415
Authors: Reding Kerryn , O'Connell Nathaniel S , Szewczyk Warren , Cheng Richard K , Nguyen Johnny , Ladd Amy C , Jordan Jennifer H , Lucas Alexander R , Sheppard Vanessa B , Ge Yaorong , Salloum Fadi N , Kim Youngdeok , Lesnefsky Edward J , Franco Robert L , Melendez Giselle C , Sutton Arnethea L , Dagostino Ralph , Weaver Kathryn E , Lesser Glenn J , Hundley William G
Published: June 2023

Introduction:
Breast cancer (BC) treatment toxicity contributes to elevated rates of cardiovascular morbidities, such as reduced exercise capacity, a risk factor for long-term cardiovascular disease (CVD) and mortality. Past studies have shown that Black women experience greater cardiotoxicity after BC treatment than white women. No studies have investigated racial differences in exercise capacity. The lack of longitudinal data leaves uncertainty as to whether greater declines in exercise capacity are experienced by Black BC survivors.

Methods:
This cohort was comprised of 236 women with stage I-III BC (80% white; 20% Black) and 130 cancer-free controls in the UPBEAT (NCT02791581) and DETECT (NCT01719562) studies. Submaximal exercise capacity was obtained via 6-Minute Walk Distance (6MWD, meters [m]) at baseline (pre-treatment) and 3 months. Linear regression was used to examine associations of race with baseline 6MWD and changes in 6MWD.

Results:
Mean age [SD] of BC survivors was 55.7 [10.9] years. Mean [SD] total meters walked pre-treatment was lower in Black women with BC (423 m [81.0]) than white women with BC (475 m [87.7]; p=0.01), and lower than Black women without BC (471 m [76.9]; p=0.07). Black BC survivors experienced a greater mean decline from baseline to 3-months in 6MWD (30 m [68.5]) than white BC survivors (21.7 m [86.6]; Table 1; p=0.02) or Black women without BC (9.2 m [67.3]; p=0.001), translating to a mean difference of 60 m between Black and white BC survivors during BC treatment.

Conclusions:
This is the first study to suggest racial differences in submaximal exercise capacity during BC treatment. Black BC survivors experienced a greater reduction in exercise capacity than white BC survivors after cancer treatment as early as 3-months post-diagnosis. This clinically-meaningful difference in exercise capacity warrants further investigation, particularly to determine interventions to reverse the loss of exercise capacity.
Abstract 15473: A New Metabolic Phenotype in a Mouse Model of Chronic Kidney Disease and Atherosclerosis
Authors: Padalkar Mugdha V , Gelfman Ylona , Kasiyanyk Mariya , Kaungumpillil Neil , Singh Mohnish , Schram Eric , Tsivitis Alexandra , Savinova Olga V
Published: June 2023

Introduction:
Patients with chronic kidney disease (CKD) experience significant cardiovascular morbidity and mortality. Vascular calcification is a hallmark of CKD and a strong predictor of atherosclerotic cardiovascular disease.

Hypothesis:
We hypothesize that CKD-induced vascular calcification potentiates atherosclerosis.

Methods:
First, wished to conduct a pilot study to confirm that a co-treatment of the low-density protein receptor mutant mice (Ldlr
whc
) with a 0.2% adenine in a western diet will produce accelerated atherosclerosis, consistent with a well-known phenotype in the 5/6 nephrectomy model on an ApoE or Ldlr knockout background. Then we developed a two-step non-surgical mouse model in which the induction of calcification by a 0.2% adenine treatment was followed by western diet-induced hyperlipidemia.

Results:
Contrary to expected, the adenine and western diet (W+A) co-treatment resulted in a striking reduction of plasma triglycerides (TG), aortic root atherosclerosis, and liver lipids despite a fully penetrant CKD phenotype with tubulointerstitial damage, increased blood urea nitrogen, hyperphosphatemia, polyuria, vascular calcification, and osteoporosis. The two-step induction of CKD and atherosclerosis demonstrated partially normalized but reduced plasma triglycerides and liver lipid content, polyurea, and polydipsia in CKD mice, and there was no difference in atherosclerotic burden or plaque calcification between the groups. Interestingly we observed an increase in food and calorie intake and 24-hour glucose excretion in the urine in the pre-treated group compared with mice on a western diet without pre-treatment, while plasma glucose levels were not different between the groups.

Conclusion:
The paradoxical lack of dyslipidemia in mice treated with adenine provides an insight into the potential effects of tubulointerstitial kidney disease and nephrogenic diabetes incipits on lipid metabolism and atherosclerosis. 1
Abstract 15490: The Association Between Measurements of Body Composition and the Prevalence of Hypertension, Diabetes and Dyslipidemia in Patients Without Coronary Artery Disease
Authors: Bianchettin Rosana G , Medina-Inojosa Betsy , Sheffeh Mohammad Ali , De Leon Andrea , Lei Sha , Johnson Lynne A , Saeidifard Farzane , Chacin Suarez Audry , Medina-Inojosa Jose R , Lopez-Jimenez Francisco
Published: June 2023

Background:
The body Mass Index (BMI) is commonly used in clinical practice to screen for obesity and resulting cardiometabolic conditions. Nonetheless, BMI has limited utility as it cannot differentiate body fat (BF).

Hypothesis:
We tested the hypothesis that BF content measured by air displacement plethysmography (Bod-Pod®) had a stronger association with prevalent hypertension (HTN), diabetes mellitus (DM) and dyslipidemia (DLP) when compared to BMI.

Methods:
We performed a community-based cross-sectional study on adults attending an employee wellness center from January 2007-December 2011 who had had a body composition assessment with Bod-Pod®. We excluded subjects with history of myocardial infarction, coronary artery disease, congestive heart failure, stroke at baseline. The prevalence of HTN, DM and DLP was assessed across quartiles of BF% and BMI categories. Their association with BF% and BMI was evaluated using linear regression models that adjusted for age, sex, and white race.

Results:
We included 3,052 individuals; 68 % were women, and the mean age ± SD was 42.09±12.8, BMI was 27.9±6.2; BF% 31.88±10.69, 892 (29.2%) were obese by BMI. Cardiometabolic conditions were prevalent in 496 (16.2%) with HTN, 378 (12.4%) with DM and 743 (24.4%) with DLP. While the prevalence of DM, HTN and DLP increased across BF% quartiles (all p for linearity>0.01), this was not always the case across BMI categories (p for linearity<0.05 for HTN and DLP, and 0.04 for DM) see
Figure A
. Elevated BF %, better identified individuals with HTN (AUC 0.766 vs 0.625; p<0.001), DM (AUC 0.643 vs. 0.568; p<0.001), DLP (AUC 0.758 vs. 0.593; p<0.001).

Conclusion:
BF content is better associated with a higher prevalence of HTN, DM, and DLP. Highlighting the role of body composition assessment in primary prevention. Dyslipidemia.
Abstract 15494: Characterization of Adiponectin Kinetics and Adiponectin R2 Pathway in Thp-1 Macrophages and Foam Cells
Authors: Hafiane Anouar , Bertrand Jean-Claude , Daskalopoulou Stella S
Published: June 2023

Background:
Adiponectin (APN) is an adipokine most abundantly secreted by adipocytes and possesses vasculoprotective properties. We and others have previously showed that APN receptor 2 (adipoR2) pathway is impaired in foam cells when compared to macrophages. Nevertheless, the functional role of adipoR2 pathway in foam cells has not been fully investigated. We hypothesize that APN kinetics involving AdipoR2 and its subsequent downstream signaling peroxisome proliferator-activated receptor-α (PPAR-α) expression are altered in foam cells when compared to macrophages.

Methods:
We used THP-1 human macrophage-derived foam cells loaded with oxidized LDL (60μg/ml) and 3H-cholesterol (2μCi/ml) versus control macrophages. APN isomers and PPAR-α protein expression were detected by gradient SDS-PAGE, and Western blotting, respectively. Media cell cultures mixtures were analysed under protease inhibitor by a size-exclusion centrifugal filter molecular weight cut-off 10 kDa.

Results:
PPAR-α activation significantly increased in APN-treated macrophages (24h) when compared with APN-treated foam cells (24h) with a maximum fold difference of 1.90±1.21, p=0.002 at 10μg APN/mL (PPAR-α: β actin ratio, spectral count; n=10 repeats for each). As a result, in foam cells, APN stimulated PPAR-α with a lower Km molar efficiency (0.06 ± 0.13 μM) and lower velocity Vmax 0.67±0.08 /h-as compared to macrophages (0.023±0.02 μM and 1.37±0.11 /h respectively, p=0.01 for both). In macrophages, APN had smaller dissociation constant Kd (0.037±0.56 μM) than in foam cells (0.10±1.30 μM). APN increased significantly PPAR-α activity rate over time reaching a maximum of 2h, with 1.19±0.02 PPAR-α protein expression in macrophages vs 0.85±0.057 in foam cells. Additionally, the APN dimer/monomer ratio increased over 24h when compared to foam cells, reaching a maximum at 2h in macrophages. Strong correlations were noted between PPARα and APN dimers: in macrophages (r=0.85; p=0.006) and in foam cells (r=0.68, p=0.05).

Conclusion:
APN stimulates PPARα activity in macrophages, but significantly less in foam cells (weaker kinetic affinity process), suggesting that APN interaction and binding with adipoR2 and subsequent downstream PPARα expression are affected in foam cells.
Abstract 15498: Treatment Adherence in Patients With Non-st Elevation Acute Coronary Syndrome
Authors: Campos Cervera Lucia Victoria , Costabel Juan P , Viruel Marcos , Muñoz Florencia , ZAIDEL EZEQUIEL , Arbucci Rosina , Perez Gonzalo , Bonorino JosÃ©
Published: June 2023

Introduction:
Optimal medical treatment demonstrated a reduction in cardiovascular outcomes after acute coronary syndrome. Treatment adherence results crucial to obtain that benefit, we do not have current data on the adherence in our population. Our objective was to evaluate the treatment adherence at 6 and 15 months in patients post non-ST elevation acute coronary syndrome (NST-ACS).

Methods:
It’s a prespecified sub-analysis in the prospective registry BUENOS AIRES 1 that include 1100 patients. The adherence was evaluated using the modified Morisky-Green scale.

Results:
The mean age was 65 ±11 years. At 6 month 76.4% were consider as adherents to pharmacological treatment. We didn’t find any predictors for adherence. Adherent patients had a rate of combined isquemic events (myocardial infarction, death or stroke) of 11.5% (52/452) versus 20% (27/135) in non-adherent patients at 15 months. Treatment adherence was an independent predictor of combined isquemic events (HR 0.517, IC95% 0.308-0.869, p=0.013). There weren’t any differences in the hemorrhagic events between the two groups.

Conclusions:
Our population had a high adherence treatment without any clinical predictor of this phenomenon. Adherence was related to a reduction in isquemic events without changing the hemorrhagic events. Nonetheless, one of four patients was considered as non-adherent after a hospitalization for NST-ACS, showing that we need intervention to reduce this number.
Abstract 15532: Pressure Measurement From a Peripheral Iv Correlates Well With Invasive Central Venous Pressure Measurement
Authors: Ruge Max , Traczuk Ashley , Ruggiero Nicholas J , Gibson Gregory , Rajapreyar Indranee , Brailovsky Yevgeniy , Shah Mahek
Published: June 2023

Introduction:
Despite its importance in cardiac patients, accurate central venous pressure (CVP) estimation remains a challenge. Noninvasive methods, such as jugular venous pressure measurement, are highly dependent on examiner experience, and the gold-standard invasive methods require procedures that carry risk of complication. Recent studies suggest that pressure measurement directly from a patient’s peripheral intravenous (IV) catheter, termed peripheral venous pressure (PVP), appears promising as an accurate and noninvasive method for CVP estimation.

Methods:
To be included in the study, patients were either receiving right heart catheterization (RHC) or had an existing pulmonary artery catheter (PAC) in place. CVP was measured using standard technique either during RHC or at bedside from the PAC. The same pressure tubing was then connecting to the patient’s existing IV, regardless of the location or catheter gauge, for measurement of the PVP.

Results:
Seventeen patients were prospectively enrolled. The majority (70.6%) had their CVP and PVP measured during RHC. In the overall cohort, 35.3% were on mechanical circulatory support, and 29.4% were on inotropes at the time of measurement. CVP and PVP measurements were significantly correlated with one another (Pearson’s r = 0.73, p < 0.001; Figure 1A). Sensitivity analysis was performed to exclude one notable outlier, which strengthened the correlation (Pearson’s r = 0.91, p < 0.001; Figure 1B).

Conclusions:
This data suggests that PVP is a promising and simple method for the noninvasive estimation of CVP.
Abstract 15598: Sexual Dimorphism in Hospital Outcomes Among COVID-19 Hospitalizations
Authors: Appunni Sandeep , Ramamoorthy Venkataraghavan , Ahmed Md Ashfaq , Zhang Zhenwei , McGranaghan Peter , Morcos Ramez , Salami Joseph , Rubens Muni , Saxena Anshul , Veledar Emir , Jimenez Javier , Chaparro Sandra
Published: June 2023

Introduction:
According to recent global estimates there are nearly 530 million cases and 6.3 million deaths due to novel coronavirus disease 2019 (COVID-19) pandemic. Studies have shown that COVID-19 disproportionately affects males than females. In this study we looked at differences in in-hospital outcomes of COVID-19 based on sex using a larger administrative database.

Hypothesis:
The adverse in-hospital outcomes of COVID-19 will be significantly higher among males.

Methods:
This was a retrospective analysis of the California State Inpatient Database 2020. All COVID-19 hospitalizations with age 18 years and above were included for the analysis. These hospitalizations were classified into males and females. The main outcomes of the study were in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission. Any length of stay ≥75th percentile value for the entire cohort was considered as prolonged length of stay. Logistic regression analyses after adjusting for covariates were used to compare COVID-19 related outcomes between males and females.

Results:
A total of 95,180 primary COVID-19 hospitalizations were included for the analysis. Of these 52465 (55.1%) were males and 42715 (44.9%) were females. Among these hospitalizations, mortality (12.4% versus 10.1%, P<0.001), prolonged length of stay (30.6% versus 25.8%, P<0.001), vasopressor use (2.6% versus 1.6%, P<0.001), mechanical ventilation (11.8% versus 8.0%, P<0.001), and ICU admission (11.4% versus 7.8%, P<0.001) were significantly higher among males. Logistics regression analysis showed that males had significantly greater odds for mortality (aOR, 1.38, 95% CI: 1.32-1.44), prolonged length of stay (aOR, 1.35, 95% CI: 1.31-1.39), vasopressor use (aOR, 1.59, 95% CI: 1.51-1.66), mechanical ventilation (aOR, 1.62, 95% CI: 1.47-1.78), and ICU admission (aOR, 1.58, 95% CI: 1.51-1.66).

Conclusions:
Adverse outcomes such as mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission were independently associated with male sex. These findings could be due differences to both biological and social factors between the sexes. Future studies should explore these factors to efficiently control COVID-19.
Abstract 15654: Mitral Valve Strands in a Patient With Cerebellar Infarcts
Authors: Achuthanandan Supraja , Cordeiro Nikhil , Dhaliwal Amit , Sadiq Adnan
Published: June 2023

Case Description:
A 56-year-old man with a history of hypertension, diabetes, hyperlipidemia, and ischemic stroke 2 years ago presented with left-sided weakness, unsteady gait, and vomiting for 12 hours. The patient was vitally stable, and examination revealed dysarthria, left ataxic hemiparesis, and chronic right facial droop. Magnetic Resonance Imaging (MRI) brain showed an evolving acute infarct in the left superior cerebellum with trace petechial hemorrhage, chronic small right posterior inferior cerebellar infarct, and chronic bilateral cerebellar lacunar infarcts. The patient had an implantable loop recorder placed after his previous stroke, which did not show any arrhythmias on interrogation. MRI Angiography of the head/neck did not show large vessel occlusions. Transesophageal echocardiography (TEE) ruled out a patent foramen ovale but did reveal multiple filamentous structures (<5mm in size) on the atrial side of the posterior mitral valve leaflet (figure 1); these were consistent with fibrin valve strands, or Lambl’s excrescences (LE). Anticoagulation therapy was started, and surgical excision was recommended.

Discussion:
LE are rare fibrous/filamentous valvular strands caused by wear and tear at the closure lines of left-sided heart valves. LE can be associated with thromboembolic strokes and acute coronary syndromes; however, it can also be found incidentally. TEE is the gold standard in diagnosis. This is a middle-aged man without a clear cause of ischemic strokes, subsequently found to have LE on the mitral valve. There is a paucity of evidence on the management of LE due to its rarity. Prior case reports suggest the use of antiplatelets/anticoagulants in symptomatic patients and surgery in cases of recurrent thromboembolic episodes refractory to conservative treatment. Given multiple strokes, this patient was started on anticoagulation and will be evaluated for surgery. Further high-powered studies are needed to guide management.
Abstract 15684: Prognostic Value of Cardiac Damage Staging in Adults With Repaired Coarctation of Aorta
Authors: Andi Kartik , Ramachandran Dhanya , Abozied Omar , Goda Ahmed , Egbe Alexander C
Published: June 2023

Background:
Chronic left ventricular (LV) pressure overload is common in adults with repaired coarctation of aorta (COA). However, there is no validated systematic approach for assessing cardiac remodeling and damage in this population. The purpose of this study was to evaluate the role of cardiac damage staging scheme (validated for calcific aortic stenosis) for prognostication in adults with repaired COA.

Methods:
Patients were classified using a modified cardiac damage scheme: stage 0 (no cardiac damage), stage 1 (LV damage), stage 2 (left atrial damage), stage 3 (pulmonary vascular/tricuspid valve damage), and stage 4 (right ventricular damage).

Results:
Of 795 patients (age 36±16 years), 270 (34%) had stage 0, 198 (25%) had stage 1, 225 (28%) had stage 2, 37 (5%) had stage 3, and 65 (8%) had stage 4 cardiac damage. The 795 patients were followed for 7.3 (2.8-9.6) years, and 94 (12%) died, of which 75 (9%) were cardiovascular deaths. Cardiac damage stage was independently associated with all-cause mortality (adjusted HR 1.31, 95% CI 1.22-1.40, per unit increase in stage), and cardiovascular mortality (adjusted HR 1.42, 95% CI 1.28-1.55, per unit increase in stage). The addition of the cardiac damage stage to the base model (clinical and echocardiographic variables) provided significant incremental improvement in the prediction of 5-year risk of all-cause mortality over the base model (net reclassification index 0.39, p<0.001). Hypertension was associated with cardiac damage and mortality.

Conclusions:
The cardiac damage scheme can be used for risk stratification, and potentially guide therapy in the COA population.
Abstract 15701: Histone Deacetylase 6Inhibition Demonstrates Comparable Efficacy as Empagliflozin in a Mouse Model of Heart Failure With Preserved Ejection Fraction
Authors: Yang Jin , Zeng Aliya , Vaziri Sara , Wu Iris , Greer-Short Amara , Farshidfar Farshad , Song Xiaomei , Argast Gretchen , Vora Jay , Holdren Matt , Hoey Tim
Published: June 2023

Background:
Heart failure with preserved ejection fraction (HFpEF) is associated with high morbidity and mortality, yet there are few effective therapies for HFpEF. Previously, we have demonstrated that TN-301, a highly selective small molecule inhibitor of histone deacetylase 6 (HDAC6), works directly on the heart and on systemic metabolism and inflammation in mouse models of HFpEF. Recently, empagliflozin, a selective inhibitor of sodium-glucose transport protein (SGLT2) inhibitor, was approved in the U.S. for patients with HFpEF.

Purpose:
We aimed to compare the efficacy of HDAC6i and SGLT2i in a mouse model of established diastolic dysfunction with preserved ejection fraction.

Methods and Results:
To recapitulate systemic and cardiovascular features of HFpEF in humans, we induced diastolic dysfunction with a combination of high fat diet and inhibition of constitutive nitric oxide synthase using N
ω
-nitrol-arginine methyl ester (L-NAME). After the HFpEF phenotypes were established, mice received TYA-11018 (TN-301-like HDAC6i) or empagliflozin, or vehicle orally once daily for 9 weeks. We found that TYA-11018 reduced left ventricular hypertrophy and restored diastolic function with comparable efficacy to empagliflozin. In addition, TYA-11018 reduced fasting glucose and improved glucose tolerance in HFpEF mice, to levels similar to empagliflozin. Preliminary data suggested TYA-11018 corrects hyperglycemia independently of glucose urine excretion, which is distinct from SGLT2i. Using whole transriptome RNA-seq, TYA-11018 showed greater effects on correcting expression of gene sets associated with inflammation, fibrosis and mitochondrial energy production compared to empagliflozin in HFpEF hearts.

Conclusion:
Our results show that with its distinct HDAC6 inhibition mechanism, TYA-11018 reverses preexisting hypertrophy, diastolic dysfunction and glucose tolerance, demonstrated similar efficacy to that with a SGLT2 inhibitor in HFpEF model. The comparable efficacy seen in this HFpEF model with TYA-11018 and empagliflozin provides early but encouraging evidence of the potential translatability of these findings to clinical development. We are developing TN-301 for treating HFpEF patients.
Abstract 15739: Utility of 30-Day Risk Adjusted Home Time as a Hospital Performance Metric for Transcatheter Edge-to-Edge Mitral Valve Repair
Authors: Mentias Amgad , Desai Milind Y , Keshvani Neil , Girotra Saket , Krishnaswamy Amar , Hirji Sameer , Harb Serge C , Kumbhani Dharam J , Saad Marwan S , Kapadia Samir R , Pandey Ambarish
Published: June 2023

Introduction:
While the utilization of mitral valve transcatheter edge-to-edge repair (TEER) procedures continues to increase over time, a validated, patient-centered, hospital-level performance metric for TEER is lacking

Hypothesis:
We examined the utility of 30-risk adjusted home time (HT) as a hospital-level performance metric for TEER procedure and compared it with the established volume, 30-day readmission, and 30-day mortality-based measures.

Methods:
Medicare patients who received TEER from 2013 to 2019 were identified. HT is defined as time spent alive and out of a hospital, skilled nursing facility, or long-term facility 30 days after TEER. Hospital-level risk-standardized measures of 30-day HT, readmission (RSRR), and mortality (RSMR) were developed using standard risk-adjustment models and correlation between these performance metrics was estimated by Pearson correlation. Longer-term patient-level outcomes of 1-year mortality and readmission were also compared across quartiles of hospitals on 30-day HT.

Results:
Overall, 24,420 patients who underwent TEER in 344 hospitals were included (mean age 80 y, 54% men, 7% Black race). At the hospital level, the median risk-adjusted 30-day HT was 24 days. There was significant inverse correlation between risk adjusted 30-day HT and 30-day RSRR (r=-0.43), 30-day RSMR (r=-0.5), and modest correlation with hospital’s annual TEER volume (r=0.11, P=0.05). The 1-year readmission and mortality among patients undergoing TEER decreased across increasing 30-day HT categories (Figure). 30-day HT (vs. annual TEER volume) meaningfully reclassified hospital performance in 34% of the hospitals with lower 1-year mortality and readmission among hospitals that were up classified (vs. no change) in performance ranking.

Conclusions:
Risk-adjusted 30-day HT is a patient-centered, comprehensive quality metric to assess hospital performance in TEER that correlates with important short- and long-term outcomes.
Abstract 15742: Thoracic Aortic Aneurysmal Disease Prevalence and Outcomes in Women With Connective Tissue Diseases
Authors: Nasir Afsheen , Zafar Mohammad , Kalyanasundaram Asanish , Sonsino Alexandra , Papanikolaou Dimitra , Tanweer Maryam , Li Yupeng , Ziganshin Bulat A , elder robert , campbell katherine , Cohen Lawrence S , Elefteriades John A , Chou Josephine
Published: June 2023

Introduction:
Connective tissue disease patients are at risk for thoracic aortic aneurysm (TAA) and its complications. We sought to clarify risk factors for TAA specific to women.

Methods:
Using Yale Aortic Institute database, we identified 266 female patients with diagnosis of Marfan’s, Ehlers-Danlos, or Loeys-Dietz Syndromes. We included imaging, clinical and surgical information collected using retrospective chart review.

Results:
Amongst women with CTD, the prevalence of TAA in our population was 25%. MFS patients constituted 23% of the study population but accounted for 70% of aneurysm patients. EDS patients comprised 74% of the study population and 24% aneurysm patients. LDS comprised a small percentage of both populations. Non-Caucasian ethnicities seemed to have much higher likelihood of developing an aneurysm. CTD patients with aortic aneurysms were more likely to have valvular heart disease (VHD: MVP, AI), HTN, DLP, and DM. Aneurysm rates were slightly higher in ever-pregnant patients, with highest rates in MFS. TAA patients had higher rates of all-cause mortality (15% vs 2%). CV/aortic-related complications and death occurred only in TAA patients. Aortic dissection occurred in 24%; 30/67 required aortic surgery, with 13/67 requiring multiple surgeries. MFS manifested higher rates of aortic dissection (40%), surgery (40%), and mortality (both all cause and CV/Ao).

Conclusions:
TAA is common amongst women with CTD, with Marfan’s patients being at highest risk for TAA and its complications (aortic dissection, need for surgery, and death). Risk factors for TAA were VHD, HTN, DLP, and DM. Pregnancy appears to be a risk factor for TAA in select CTD subgroups.
Abstract 15771: Disparities in Cardiovascular Death Proportions Based on Age-Standardized Gross Domestic Product Classification of Countries: Global Burden of Disease 2019
Authors: Titus Anoop , Dasari Mahati , Avinashsingh Eswarsingh FNU , Baburaj Abiram , Saji Anu , sharma arushi , Arun Kumar Pramukh , Dani Sourbha
Published: June 2023

Introduction:
Socioeconomic status impact cardiovascular disease outcomes. There is a paucity of data comparing age-standardized Gross Domestic Product (aGDP) and age-based proportion of CVD deaths (pCVD).

Methods:
We analyzed World Development Indicators and Global Burden of Disease 2019 study data. aGDP, CVD, total all-cause deaths, and their distribution amongst ‘High Income’ (HI), ‘Upper-Middle Income’ (UM), ‘Low-Middle Income’ (LM), and ‘Low Income’ (LI) countries from 2010-2019 was queried. ANOVA with Kruskal-Wallis Test followed by post-hoc analysis with Tukey test was conducted to examine the differences in pCVD among different income category countries based on age groups (Table 1b).

Results:
A total of 169,825,716 CVD (35.4%) were noted out of 478,797,297 total all-cause deaths globally. There was a significant difference comparing all income classes (p < 0.001) in age groups except between UM and LI in the age groups 15-49 and 50-69 (p = 0.885 and 0.261 respectively). In the age group 5-14, pCVD was higher in HI, UM, LM and LI classes (3.74%, 3.41%, 2.48 and 1.96%, p < 0.01). In age groups 15-49, pCVD was higher in UM and LM (17.70%, 17.50%), and lower pCVD in HI and LI classes (15.07% and 8.52%). At the age > 70, higher pCVD was seen in UM, followed by LM, LI, and HI (50.05%, 40.93%, 36.74% and 35.78% respectively, p < 0.001). The highest overall pCVD was observed in the UM class.

Conclusions:
Our study shows a statistically significant difference in pCVD between the World Bank classes of countries based on age groups. There is higher pCVD in HI, both-middle-income, and UM classes in the age groups 5-14,15-69, and >70 respectively, with overall pCVD being higher in UM class.