bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14777: Effectiveness of Virtual vs Face-to-Face Medical Nutrition Therapy in Patients With Hyperlipidemia
Authors: Zoulek Shannon , Shriver Jackson , Kaur Navkiranjot , Kuznicki Beverly , Brandt Eric
Published: December 2023

Introduction:
Medical nutrition therapy provided by registered dietician nutritionists (RDNs) is an effective therapy for treating lipid disorders. There has been a shift in practice for patients to receive nutrition counseling virtually rather than in-person.

Hypothesis:
We evaluated whether virtual nutrition visits are as effective as face-to-face (F2F) visits at reducing lipid levels.

Methods:
We performed an observational study of patients seen by a RDN as part of the University of Michigan Preventive Cardiology lipid management program from 3/31/2019 - 9/31/22. Lipid markers, including total cholesterol (TC), high-density lipoprotein (HDL), and triglycerides (TG) were collected prior to meeting with an RDN and a median of 33 days later. Low-density lipoprotein (LDL) was calculated using the Sampson equation (patients with TG >800 mg/dL were excluded). We used a paired T-test to evaluate the mean difference in lipid marker pre-post visit. Linear regression was used to compare the impact of virtual and F2F nutrition visits.

Results:
192 patients were included (41 virtual visits and 151 F2F visits). After a single virtual or F2F visit with an RDN, TC, LDL, and non-HDL decreased (all p-values <0.05, Figure). HDL decreased for F2F visits only. Change in TG was not significant for either group. There were no significant differences between virtual and F2F for changes in mean pre-post visit for any lipid markers (TC p=0.37, LDL p=0.54, non-HDL p=0.29, HDL p=0.72, TG p=0.67).

Conclusions:
Both virtual and face-to-face RDN visits lead to overall improvement in lipid profiles at post-visit follow-up. Telehealth is an effective way for patients to receive nutrition counseling and may help to overcome barriers in access to treatment for hyperlipidemia.
Abstract 14800: Alzheimer’s Disease and Related Dementias (ADRD) Limits Days at Home Among Medicare Beneficiaries Hospitalized for Heart Failure (HF)
Authors: Sterling Madeline R , Espinosa Cisco G , Mitlak Hannah , Kheirbek Raya E , Thompson Mike P , Levine Deborah A , Falvey Jason
Published: December 2023

Background:
Alzheimer’s disease and related dementias (ADRD) are highly prevalent among adults with heart failure (HF). HF is associated with disability among older adults, especially those with ADRD. This may impact aging in place after HF hospitalizations, which is concerning given this is an important outcome for patients recovering from serious illnesses. We aimed to examine the association between ADRD and aging in place among Medicare beneficiaries hospitalized for HF.

Methods:
We identified 80,694 fee-for-service beneficiaries hospitalized for HF between 2017 and 2019 in a 20% random sample of Medicare claims. HF hospitalization and ADRD were identified using ICD codes. The primary outcome was restricted home time, a patient-centered claims-based measure of successful aging in place defined as spending ≥ 10 days not at home (e.g., hospitalized, nursing home, inpatient facility) over 6 months post-discharge. Multivariable logistic regression was used to examine the association between ADRD and restricted home time adjusting for demographic and clinical characteristics; secondary analyses evaluated the likelihood of returning to pre-hospitalization days at home 6 months post-discharge.

Results:
Eighteen percent (n= 14,503/80,694) of adults hospitalized for HF had concurrent ADRD. HF patients with ADRD were older (83 vs 77 years), more likely to be female (56% vs 48%), and have dual Medicaid/Medicare eligibility (27% vs 21%), but had similar hospital length of stays and days at home preceding HF hospitalization compared to those without ADRD. Of HF patients with ADRD, 63% had restricted home time (vs. 51% without ADRD) and 52% failed to return to baseline days at home (vs. 42% without ADRD). In adjusted models, older adults with ADRD had 34% greater odds of experiencing restricted home time (OR=1.34, 1.30-1.40), and 20% lower odds of returning to baseline days at home (OR=0.80, 0.77-0.83) 6 months post- discharge than those without ADRD.

Conclusions:
HF hospitalizations impact the ability of older adults to successfully age in place, especially among those with ADRD. Tailored post-discharge care solutions are urgently needed to address the challenges faced by HF patients with ADRD.
Abstract 14804: Automated Semantic Segmentation and Stenosis Detection of Coronary Arteries on Invasive Coronary Angiograms Using Hypergraph Matching and Information Fusion
Authors: Zhao Chen , Esposito Michele , Jiang Jingfeng , Xu Zhihui , Zhou Weihua
Published: December 2023

Background:
Invasive coronary angiography (ICA) remains the gold standard for diagnosing CAD. Our objective was to develop a machine learning method for coronary semantic segmentation and stenosis detection in ICA.

Method:
We first extract coronary artery branches using ICAs and convert the vascular tree into ICA graphs. Then, we construct the hyper association graph from two individual ICA graphs. The vertex in the hyper association graph encodes the correspondence between two artery branches, and each hyperedge represents the correspondence between multiple artery branches. Hypergraph matching is used to find feature correspondence by considering higher-order structural information, and the artery semantic labeling task is converted into a vertex classification. Ultimately, by learning the semantic mapping of artery branches between ICAs, the unlabeled arteries are categorized by labeled arteries so that semantic segmentation is achieved. After performing the semantic labeling, a deterministic network performs stenosis detection. More specifically, a convolution long-short-term network is employed to extract imaging features, and an LSTM is employed to extract the radius features along the artery. The late fusion technology is employed to fuse the feature representation, and a softmax classifier is employed to detect the stenosis.

Results:
310 ICAs from 179 subjects were collected and utilized for data analysis. Our graph-matching model achieved an average accuracy of 0.86 for coronary artery semantic labeling. The deterministic network achieved an accuracy of 0.80 for coronary artery stenosis detection.

Conclusion:
We have developed and validated a hypergraph-based graph-matching algorithm for coronary semantic labeling and a fusion network for artery stenosis detection. This has important implications for integrating AI software in ICA, potentially resulting in automated report generation or as an assistant for clinical decision-making.
Abstract 14807: Direct Carotid Sinus Nerve Stimulation in Anesthetized Human Subjects
Authors: Baskin Jonathan , Pinault Gilles , Heald Elizabeth , Tyler Dustin , Dunning Jeremy , Majerus Steve
Published: December 2023

Introduction:
Drug resistant hypertension is a growing clinical phenomenon across the world and there is a critical need for alternative therapeutic modalities.

Hypothesis:
A novel multi-contact electrode designed to interface with the carotid sinus nerve in conjunction with a unique implantation technique can selectively activate the baroreflex causing reversible drops in blood pressure (BP) & heart rate (HR) in anesthetized humans.

Methods:
Patients undergoing therapeutic operations that necessitated carotid bulb exposure were prospectively enrolled in this IRB approved trial. Using a novel surgical approach, an application specific electrode was placed around the CSN followed by contact interface mapping to identify presumed baroafferent fibers which were selectively stimulated. Outcome measures included change in systolic BP (SBP), diastolic BP (DBP), and HR during and after stimulation.

Results:
14 subjects met eligibility criteria. In 13, following correct contact identification, stimulation caused a 23±20mmHg (mean±SD) maximum drop in SBP with associated drops in DPB (11±9mmHg), and HR (10±9bpm). All subjects recovered immediately following stimulation withdrawal. All drops were significant (p<0.001, t-test). In subjects with baseline SBP >120mmHg (n=8), maximum SBP drop was 30±23mmHg, while subjects with baseline SBP <120mmHg (n=5) exhibited a maximum SBP drop of 11±3mmHg. There was evidence of a positive dose (current) response relationship.

Conclusions:
Using a novel surgical approach and electrode, CSN stimulation in anesthetized human subjects caused a marked drop in BP/HR followed by rapid recovery with stimulation withdrawal. There was evidence of dose dependency.
Abstract 14816: PCSK9 Inhibitors Modify Plaque and Reduce Plaque Progression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Lima Ana E , Vilas Boas Gustavo , Carvalho Ferreira Andre L , Benitez Gonzalez Maria , Guida Camila
Published: December 2023

Introduction:
Elevated coronary plaque burden and high-risk plaque characteristics, such as thin fibrous cap, are associated with an increased risk of adverse cardiovascular events. However, there is limited evidence on the effect of PCSK9 inhibitors (PCSK9i) on changes to plaque burden and composition.
Hypothesis:
We aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of standard lipid-lowering therapy with vs. without PCSK9i on plaque burden and phenotype.

Methods:
We searched PubMed, Embase and Cochrane Central for studies that performed serial intravascular imaging comparing patients with vs. without PCKS9i therapy. Two reviewers independently performed study selection, data extraction and assessment of bias. All outcomes were continuous; thus, we computed pooled mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (CI). Random-effects models were used. Statistical analysis was performed using Review Manager 5.4.1.

Results:
We included 1,696 patients from 6 RCTs. The mean follow-up ranged from 36 to 76 weeks. Mean age ranged from 58.4 to 61.8 years; 1,246 (65%) were male; and 368 (21.6%) had previous myocardial infarction. Percent atheroma volume (MD -1.05%; 95% CI -1.32, -0.77%; p<0.001), total atheroma volume (MD -6.33 mm
3
; 95% CI -10.01,-2.66 mm
3
; p<0.001), and total lipid index (SMD -0.58; 95% CI -0.90,-0.26; p<0.001) were significantly reduced in patients treated with PCSK9i. The minimum fibrous cap thickness (SMD 0.59; 95% CI 0.26,0.93; p<0.001) was also significantly improved in patients randomized to PCSK9i.

Conclusions:
Our findings suggests that PCSK9i reduce progression of coronary atherosclerosis and stabilizes plaque, as evidence by favorable changes in percent atheroma volume, total atheroma volume, lipid index of the plaque, and minimal fibrous cap thickness.
Abstract 14823: Assessment of the Appropriateness and Prognostic Significance of the Current Universal Diagnostic Definition for Acute Kidney Injury in Patients After Cardiac Surgery and Exploration of Tailored Criteria
Authors: Zeng Juntong , Su Xiaoting , Huang Xiaohong , Zheng Zhe
Published: December 2023

Background:
Cardiac surgery-associated AKI (CSA-AKI) is prevalent and its diagnosis currently adheres to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, commonly used criteria developed for general populations. Limited evidence exists on their appropriateness and prognostic value for CSA-AKI, which exhibits unique mechanisms and clinical courses.

Aims:
We aimed to assess the prognostic value of the KDIGO diagnostic criteria for CSA-AKI and explore potentially more prognostically relevant criteria for cardiac surgery.

Methods:
Patients undergoing coronary artery bypass grafting surgery at a single institution were included and categorized into four groups: no AKI, AKI stage-1, AKI stage-2, and AKI stage-3, based on KDIGO guidelines. Patients of AKI-1 were further divided based on specific criteria met: absolute criteria (0.3mg/dL serum creatinine (SCr) increase over 48-hour intervals), ratio criteria (1.5-1.9 times baseline SCr), and dual criteria (meeting both criteria) AKI-1. The primary outcome was 30-day all-cause mortality.

Results:
Among 20626 patients, the overall incidence of CSA-AKI was 47.4%, with rates of 44.2% for AKI-1, 2.2% for AKI-2, and 0.9% for AKI-3. The overall 30-day mortality was 0.6%. Among AKI-1, 72.4%, 3.2%, and 24.2% met the absolute criteria, ratio criteria, and dual criteria, respectively. After multivariate adjustment, AKI-2 and AKI-3 were significantly associated with increased 30-day mortality. However, neither AKI-1 nor its subcategories showed prognostic significance. Subsequent restricted cubic spline analysis identified more prognostically relevant cut-off values for AKI-1 criteria as >0.7 mg/dL SCr increase over 48-hour intervals and >1.3 times baseline SCr, respectively.

Conclusions:
The current universal KDIGO diagnostic criteria may not be suitable for CSA-AKI, especially regarding cut-off values for AKI stage-1, highlighting the necessity of tailored criteria for cardiac surgery.
Abstract 14841: Higher Than Daily RDA Recommended Vitamin D
3
Dosing and Multiple Titrations Are Required to Achieve >40 ng/mL 25-hydroxy Vitamin D Levels in Acute Coronary Syndrome (ACS) Participants Enrolled and Randomized to Targeted Vitamin D Treatment: The Target D Trial
Authors: Le Viet T , Babcock Daniel , Wayman Libby , Maestas Heather , Anderson Jeffrey L , Knowlton Kirk U , Muhlestein Joseph B , May Heidi T
Published: December 2023

Background:
Low vitamin (vit) D serum levels in observational data are associated with increased cardiovascular (CV) events. Prevalence of vit D deficiency (≤20 ng/mL) in the USA is estimated at 40%. Meanwhile, doses for USA recommended dietary allowance (RDA) are 600-800 IU. Several randomized trials of vit D therapy did not use serum levels to target dosing, rather utilized doses from 2000 to 4000 IU daily. The Target-D trial utilizes an achieved vit D serum (>40 ng/mL) strategy. We provide an initial overview of dosing and titration to achieve vit D serum levels >40 ng/mL.

Methods:
Target-D (NCT: 02996721), a randomized event-driven trial, enrolled (April 2017-May 2023) a total of 632 (316/arm) acute coronary syndrome (ACS) patients to targeted vit D
3
treatment or standard of care. Vit D
3
supplementation was based on a dosing algorithm (Table 1). For baseline serum vit D >40, no supplementation is given, and participants return at 12-months for reassessment. Those with a baseline serum vit D ≤40, the algorithm is applied, and participants return in 3-month intervals for assessment and dosing adjustment, until levels are >40 ng/mL.

Results:
Of the 316 (62.8±11.3 yrs, 23.1% female, 90% white) treatment participants, 89.4% (n=279) required vit D
3
dosing. Mean serum vit D was 25.9±11.5 ng/mL (median: 24, range: 5-84). Table 2 shows the percent of participants achieving >40 ng/mL at each interval by dose. Only 13.5% of participants were able to achieve >40 ng/mL using
<
2000 IU, 20.8% needed 3000-4000 IU, 51% needed 5000-8000 IU, and 14.6% required
>
10,000 IU.

Conclusions:
At our center, ACS patients have low serum vit D levels. Participants randomized to vit D
3
required doses well above US daily RDA, with 86.5% requiring >2,000 daily and 14.6% requiring
>
10,000 IU. Less than 65% achieved >40 at 3 months, another 25% required 6 months. Contemporary vit D studies may have underdosed study participants, potentially achieving treatment serum levels less than “therapeutic”.
Abstract 14846: Rurality and Associated Cardiovascular Events and Mortality in Older Men With Prostate Cancer: Longitudinal SEER Medicare Analysis
Authors: Jiang Stephanie , Patel Vraj , Datta Biplab , Nain Priyanshu , Seth Lakshya , Nettles Darryl , Malik Sarah , Patel Sagar A , Rupji Manali , Ward Kevin , Switchenko Jeffrey M , Moore Justin , Weintraub Neal L , Guha Avirup
Published: December 2023

Introduction:
The effect of rurality as a social determinant of health in cardiovascular events (CVE) in patients with prostate cancer (PC) is unknown.

Methods:
Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified males ≥ 66 years old with a new primary diagnosis of PC between 2009 and 2017. We also identified those who were undergoing leuprolide androgen deprivation therapy (ADT). These patients were followed to identify a primary outcome of CVE that included heart failure (HF), atrial fibrillation (AF), acute myocardial infarction (AMI), peripheral artery disease (PAD), coronary artery disease (CAD), ischemic stroke (IS) and cardiovascular death. Adjusted Cox proportional hazards modeling was performed to estimate all-cause mortality in PC patients stratified by rurality as defined by Medicare. Adjusted Fine-Gray modeling with appropriate competing risk (mortality or type of mortality) was utilized for other outcomes as presented. We adjusted for demographic factors, social determinants of health, cancer-specific factors, and other cardiovascular risk factors apart from the primary exposure of rurality.

Results:
This study included 102,225 PC patients. Among these, 4,945 (4.8%) belonged to areas with a population of less than 2,500 or less than 20,000 not next to a metro (rural). The use of ADT was noted in 9,071 (8.9%) of patients. The incidence of new CVE and mortality risk due to rurality is presented in
Table 1.
Rural area was noted to be a risk factor for all-cause mortality [adjusted hazards ratio (aHR) = 1.114 (95% CI= 1.070-1.161)]. No statistically significant association between CVE and rurality, however, was observed in the data.

Conclusions:
PC patients have a high burden of pre-existing cardiovascular disease prior to PC diagnosis, and rurality increases all-cause mortality. This is consistent with those who are treated with ADT as well.
Abstract 14850: Streptococcus Constellatus: A Rare Cause of Cardiac Tamponade and Constrictive Pericarditis
Authors: Rahman Saad Ur , Gill Seemab Imtiaz , Haider Mobeen , Khalid Yousra , Shih Timothy , adoni naveed
Published: December 2023

Introduction:
Cardiac tamponade is an emergency medical condition referring to the buildup of fluid in the pericardial sac, which can compress the heart and lead to hemodynamic instability. Streptococcus constellatus, a member of the Streptococcus viridans group, has been implicated as a rare cause of cardiac tamponade with only 3 cases reported in the medical literature. We present a unique case of Streptococcus constellatus (S. constellatus) induced purulent pericarditis leading to cardiac tamponade and constrictive pericarditis.

Case presentation:
A 56-year-old female with no significant past medical history presented with intermittent fever, non-productive cough, and worsening shortness of breath for 2 weeks. She initially went to Convenient Care a week ago for a sore throat with a low-grade fever and was sent home with oral antibiotics. Initial vitals revealed hypotension, high-grade fever, and tachycardia. Physical examination was remarkable for elevated jugular venous pressure and muffled heart sounds. Lab work showed significant leukocytosis. EKG was remarkable for diffuse ST-elevation, low QRS voltage, and electrical alterans. A transthoracic echocardiogram (TTE) revealed severe pericardial effusion. Emergent pericardiocentesis was performed draining 370 ml of purulent fluid and post-operative TTE revealed trace pericardial effusion. Blood and pericardial fluid cultures came back positive for S. constellatus. Another trans-esophageal echocardiogram (TEE) was performed during the hospital stay that was negative for any vegetation however, revealed thickened pericardium with septal bounce suggesting constrictive pericarditis. Cardiothoracic surgery recommended repeat TTE in 3 months for possible pericardiectomy if pericardial changes persist. The patient was discharged on oral antibiotics and colchicine in stable condition.

Discussion:
S. constellatus is typically part of oral, respiratory, and gastrointestinal flora. It can reach the pericardial space through hematogenous spread or direct extension from nearby infections. Our case highlights prompt identification and appropriate treatment which are crucial for managing this potentially life-threatening and unique condition.
Abstract 14865: A Paradigm Shift in the Incidence of Early-Onset Atrial Fibrillation and Flutter
Authors: Danpanichkul Pojsakorn , Ongsupankul Sorawit , Yinadsawaphan Thanaboon , Pingwang Phakkamon , Songmueang Nonlawan , Nonthasoot Chalida , Kanjanakot Yatawee , Benjanuwattra Juthipong , Nantsupawat Teerapat
Published: December 2023

Introduction:
Atrial fibrillation (AF) and atrial flutter (AFL) are the most prevalent cardiac arrhythmias. Although the incidence and disease burden have been increasing, once adjusted for age, the standardized incidence has been decreasing, reaching 57.10 per 100,000 as of 2019. This study aims to explore this epidemiological trend pertaining to the younger population which are often underrepresented in AF/AFL studies.

Methods:
Utilizing the Global Burden of Disease (GBD) database, we calculated the incidence and disability-adjusted life years (DALYs) of AF/AFL patients aged 15-49 years along with the age standardized rates (ASR) and annual percentage changes (APC) for the incidence and DALYs from 2010 to 2019. We also calculated these values for populations according to socio-demographic index (SDI) group, region, and gender.

Result:
From 2010 to 2019, the standardized incidence and DALYs of early onset AF/AFL (EOAF/AFL) had increased globally. The APC of ASR of incidence had been +0.15% (95% confidence interval (CI) 0.21%-0.08%) and the APC of ASR of DALYs had been 0.28% (95% CI 0.36%-0.21%), respectively. Women demonstrated higher APC of both ASRs of incidence (+0.45% (95% CI 0.40%-0.50%) and DALYs (+0.50% (95% CI 0.45%-0.55%) while men experienced a stable trend of ASR of incidence and declining trend of ASR of DALYs. Geographic analysis showed that Eastern Mediterranean population had the highest APCs of both ASRs of incidence (+1.53% (95% CI 0.40%-0.50%)) and DALYs (+1.61%95% CI 0.40%-0.50%)), while both ASR and DALYs declined in the United States

Conclusion:
The incidence and DALYs of EOAF/AFL had been increasing globally, especially among women. However, rates differed by geographic region. For example, Eastern Mediterranean regions showed the largest increases across all age groups. In contrast, the incidence of EOAF/AFL had continued to decline in the United States. Future study is warranted to explore the geographical impact on the risk factors of AF/AFL.
Abstract 14896: Age is a Predictor of In-Hospital Mortality for Left Ventricular Assist Device: Implication in Post-2018 Donor Heart Allocation System
Authors: Yamaguchi Akira
Published: December 2023

Background:
The introduction of the new heart allocation system in 2018 has significantly changed the landscape of heart transplantation and trends of durable left ventricular assist device (LVAD) utilization. Although the quality of durable LVAD has improved, the impact of age on in-hospital mortality for LVAD implantation remains unknown under the new allocation system.

Objective:
We aimed to investigate the influence of age on the outcome following the LVAD implantation under the new heart allocation system.

Method:
We utilized the National Inpatient Sample to investigate patients who underwent LVAD implantation between 2019 and 2020. The primary endpoint was in-hospital mortality following LVAD implantation, stratified by different age groups. We also investigated independent predictors of in-hospital mortality.

Result:
A total of 7,375 patients underwent LVAD implantation between January 2019 and December 2020. Among these patients, individuals aged 18-49, 50-59, 60-69, and over 70 years old accounted for 26%, 26%, 31%, and 17%, respectively. In-hospital mortality rates in the aforementioned age groups were 7%, 6%, 12%, and 17%, respectively. Notably, the age groups of 60-69 and over 70 compared to age <59 exhibited independent predictors of mortality, with an adjusted odds ratio (aOR) of 1.99 (p=0.02; 95% confidence interval [CI), 1.12-3.57) and 2.88 (p=0.002; 95% CI 1.45-5.71), respectively. Charlson Comorbidity Index (aOR, 1.39; p=0.02; 95% CI, 1.05-1.84) was also associated with increased risks of mortality.

Conclusion:
Our findings indicate that individuals over 60 years-old or with higher Charlson Comorbidity Index face a higher risk of in-hospital mortality following LVAD implantation.
Abstract 14902: Prevalence and Characteristics of Myocarditis-Related Sudden Death in the General Population
Authors: Holmstrom Lauri , Mäntyniemi Lassi , Eskuri Anette , Hookana Ida , Silvola Harri , Pakanen Lasse , Huikuri Heikki , Junttila Juhani
Published: December 2023

Introduction:
Myocarditis is a frequent cause of sudden cardiac death (SCD) in young individuals (<35 years), but the frequency of myocarditis in middle-aged (35-65 years) and older SCD victims (>65 years) is unclear.

Objective:
We aimed to investigate the prevalence and characteristics of myocarditis-related sudden death in the general population.

Methods:
Our study population is drawn from the Fingesture study, which has prospectively collected all out-of-hospital SCD cases from Northern Finland (population ~700,000) since 1998. As required by Finnish law, all sudden deaths undergo a medicolegal autopsy. All out-of-hospital sudden death cases in the community with a verified cardiac cause of death at autopsy are included in the Fingesture study. By 2017, the Fingesture study had collected data on 5,869 SCD victims.

Results:
In total, 60 SCD victims had evidence of acute myocarditis at autopsy (1.0% of all SCD cases). The mean age of SCD victims with myocarditis was 55.9±18.2, which was significantly lower than among the rest SCD victims (65.0±12.3; p<0.001). Myocarditis cases were also more often female in comparison to the rest SCD cases (33.3% vs. 21.0%; p=0.02). The proportion of myocarditis was highest among young (<35 years) SCD cases (n=6/73; 8.2%), and the proportion decreased in middle aged (35-65 years) (n=34/2,948; 1.2%) and older (>65 years) SCD cases (n=20/2,848; 0.7%) (p<0.001), although the absolute number was higher. The most common diagnosis was undetermined acute myocarditis (n=42/60; 70%) followed by infective myocarditis (n=10/60; 16.7%) and pericarditis (n=5/60; 8.3%). In addition, two SCD cases had sarcoidosis and one had giant cell myocarditis. Five SCD cases due to myocarditis (8.3%) occurred during physical exercise.

Conclusions:
Myocarditis is a rare cause of SCD in the general population. Although the relative proportion of myocarditis was highest among young SCD victims, the absolute number was highest among middle-aged SCD victims.
Abstract 14921: Right Atrial Paraganglioma
Authors: Bin Farooq Talha , Paul Vishesh
Published: December 2023

Introduction:
Paragangliomas are rare tumors of neural crest cells origin and can be adrenal or extra-adrenal. They can be associated with catecholamine release in some patients and cause systemic symptoms. Cardiac paragangliomas account for less than 1% of all primary cardiac tumors.

Case Summary:
A 70-year-old woman presented to the emergency department with new-onset chest pain. Vitals were significant for elevated blood pressure but otherwise unremarkable. Physical exam and serum hematology and chemistries were unremarkable. D-Dimer was mildly elevated. Chest CT Angiogram showed a 1.5 cm right lung nodule but no pulmonary embolism. Outpatient Positron Emission Tomography (PET) scan done for further evaluation of the nodule showed no uptake in the lung nodule but a 5cm mass in the right atrium. Cardiac MRI confirmed the atrial mass with suspicion for angiosarcoma. The patient underwent surgery, and the pathology showed paraganglioma. Patient did well after the surgery.

Discussion:
Cardiac paragangliomas usually present with fatigue, atypical chest pain or heart failure. It can also present with signs of catecholamine excess. Surgery is the preferred treatment for benign paragangliomas. Surgery should be prompt as it has a potential to be malignant. Chemotherapy and radiolabeled agents are additionally used for the malignant types.

Conclusions:
There should be high clinical suspicion for secondary causes of hypertension in patients presenting with either episodic hypertension or resistant hypertension. Paragangliomas are very rare cardiac tumors and there have been very few reported cases of right atrial paraganglioma. Any suspicion of this rare tumor should prompt aggressive investigation and prompt referral to a center specializing in their removal.
Abstract 14933: A Rare Case of Cardiac Angiosarcoma Presenting as Hemorrhagic Pericardial Effusion
Authors: Mansour Christina , Jun Judy , Ranches Gregory
Published: December 2023

Cardiac sarcomas are exceptionally rare, with an incidence of only 0.02% and comprising less than 1% of all primary cardiac tumors. Consequently, diagnosis of the disease can be challenging due to non-specific presenting symptoms and diverse clinical manifestations. We present a unique case of cardiac sarcoma that highlights these challenges.

A 70-year-old man with a history of hypertension, hyperlipidemia, and latent tuberculosis presented with palpitations, chest pain, and dyspnea, was found to have hemorrhagic pericardial effusion with tamponade. Pericardial fluid studies were negative for malignancy, and echo not suggestive of cardiac mass or pericardial abnormalities. He presented several months later with hemoptysis and was found to have innumerable pulmonary nodules on CT chest and a mediastinal mass adjacent to the right atrium. Bronchoscopy was negative for infection or malignancy. Ultimately the patient underwent CT-guided lung biopsy, which showed a malignant spindle cell neoplasm with a positive stain for vimentin and vascular markers suggestive of angiosarcoma of unknown primary. Given unclear relation of his mediastinal mass, cardiac MRI was done which showed a rapidly enhancing bulky neoplasm with abnormal contrast enhancement arising from the lateral right atrium (Figure 1) consistent with metastatic cardiac angiosarcoma. Patient was started on systemic anthracycline-based chemotherapy; however the overall prognosis remains poor.

Given the rarity of cardiac sarcomas, prognosis is generally poor due to the advanced stage at the time of diagnosis. These tumors exhibit aggressive behavior and have a high propensity for metastasis. Due to their infrequency, knowledge and research is limited regarding effective treatments. This case highlights the significance of considering cardiac angiosarcoma in cases of hemorrhagic pericardial effusion even in the absence of obvious cardiac mass or pericardial nodularity on initial presentation.
Abstract 14934: Libman-Sacks Endocarditis and Sjogren’s Syndrome: Are They Associated?
Authors: Almaraz Karla B , Roldan Carlos A , Shah Ishan , Kholghi Maedeh , Pregenzler-Wenzler Arianna , Ratliff Michelle
Published: December 2023

Introduction:
Libman-Sacks endocarditis (LSE) in patients with systemic lupus erythematosus (lupus) is frequently complicated with stroke or TIA, acute or chronic progressive valve dysfunction, need for high-risk valve surgery, and increased morbidity and mortality. Sjogren’s syndrome characterized by dry eyes and mouth for >3 months and positive anti-Ro/SSA or SSB antibodies is common in lupus patients, but its association with LSE is unknown

Aim:
To determine if Sjogren’s syndrome is associated and predictive of LSE.

Methods:
76 lupus patients (71 women, 36 ± 12 years of age) and 26 age-and-sex frequency (3:1 ratio) matched controls (22 women, 34 ± 11 years of age) underwent TEE and assessment of demographics, atherogenic risk factors, and parameters of inflammation and thrombogenesis. Patients were also assessed for lupus duration, activity, injury, autoantibodies, and therapy. Libman-Sacks vegetations by TEE were defined as localized, protruding, and sessile echodensities >3 mm in diameter with well-defined borders as part of valve leaflets, annulus, or subvalvular apparatus. All studies were coded, de-identified, and interpreted by observers blinded to participants’ clinical data. Univariate and multivariate regression analyses were used to identify predictors of LSE.

Results:
39 (51%) lupus patients and 2 (8%) controls had vegetations (p<0.001). Also, 39 (51%) patients had Sjogren’s syndrome and 28 (72%) of them had vegetations (p<0.001). As shown in
Table 1
, age, Sjogren’s syndrome, current smoking, β-2 glycoprotein antibodies, lupus duration, acute or recent stroke/TIA, past stroke, lupus activity and damage scores, and anti-thrombotic therapy were univariate predictors of LSE (all p≤ 0.05). However, Sjogrens’ syndrome, acute or recent stroke or TIA, and duration of lupus were the only multivariate predictors of LSE (all p≤0.02).

Conclusions:
Sjogren’s syndrome is an independent predictor of Libman-Sacks endocarditis.
Abstract 14943: Trans-Biobank Mendelian Randomization Analyses Identify Distinct and Opposing Pathways in the Association of Lower Plasma Low-Density Lipoprotein-Cholesterol With Risk of Gallstone Disease
Authors: Yang Guo-yi , Mason Amy , Gill Dipender , Sching CM , Burgess Stephen
Published: December 2023

Background:
Higher plasma LDL-cholesterol increases coronary artery disease risk, while biliary cholesterol promotes gallstone formation. Trial evidence suggests that lowering plasma LDL-cholesterol with bempedoic acid increases gallstone risk.

Hypothesis:
Different plasma LDL-cholesterol lowering pathways have distinct effects on biliary cholesterol and thereby gallstone disease risk.

Methods:
We conducted a Mendelian randomization (MR) study using data from the UK Biobank (30,547 gallstone disease cases/336,742 controls), FinnGen (34,461 cases/301,383 controls) and Biobank Japan (9,305 cases/168,253 controls). We firstly performed drug-target MR analyses substantiated by colocalization to investigate the effects of plasma LDL-cholesterol lowering therapies on gallstone risk. We then performed clustered MR analyses followed by pathway analyses to identify distinct pathways in the association of lower plasma LDL-cholesterol with gallstone risk.

Results:
Genetic mimics of statins were associated with lower gallstone risk, but genetic mimics of PCSK9 inhibitors, mipomersen and bile acid sequestrants were associated with higher gallstone risk. The association for statins was supported by colocalization (posterior probability 98.7%). Clustered MR analyses consistently identified clusters showing opposing associations of lower plasma LDL-cholesterol with gallstone risk. Among variants predicting lower plasma LDL-cholesterol, those associated with lower gallstone risk were mapped to glycosphingolipid biosynthesis pathway, while those associated with higher gallstone risk were mapped to pathways relating to ATP-binding cassette transporters and plasma lipoprotein assembly, remodelling, and clearance.

Conclusions:
Genetic evidence suggests that different plasma LDL-cholesterol lowering pathways may have opposing effects on gallstone disease risk. Specifically, statins may reduce gallstone disease risk.
Abstract 14951: Input From Renal Afferent Nerves Contributes to Hypertensive Heart Failure With Preserved Systolic Function Through Baroreflex Impairment and Sympathoexcitation
Authors: Nakashima Ryosuke , Shinohara Keisuke , Kashihara Soichiro , Ikeda Shota , Matsumoto Sho , Yoshida Daisuke , Ono Yoshiyasu , Nakashima Hiroka , Tsutsui Hiroyuki , Kinugawa Shintaro
Published: December 2023

Introduction:
Activation of renal afferent nerves, which can be caused by hypertensive renal damage, increases sympathetic output. The nucleus tractus solitarius (NTS) receives the inputs from baroreflex afferent nerves as well as renal afferent nerves. Baroreflex dysfunction leads to increased left ventricular (LV) end-diastolic pressure even in the heart with preserved systolic function. The GABAergic inhibitory system in the NTS blunts the signals from baroreflex afferent nerves, resulting in increased sympathetic output.

Hypothesis:
Input from renal afferent nerves contributes to hypertensive heart failure with preserved systolic function through baroreflex impairment and sympathoexcitation mediated by increased GABAergic inhibition in the NTS.

Methods and Results:
Male Dahl salt-sensitive rats with 8% high-salt diet from 7 weeks of age develop hypertensive HFpEF at 19 weeks. These rats underwent sham surgery (Sham), selective afferent renal denervation (ARDN), or additionally dissection of baroreflex afferent nerves (ARDN+BAROX) at 9 weeks. As controls, rats underwent sham surgery with a low-salt diet. The rats were evaluated at 19 weeks. Systolic blood pressure was similarly elevated in the three groups on high-salt diet. Impaired LV diastolic function assessed by echocardiography and pressure-volume loop analysis in Sham was recovered in ARDN group, while systolic function was preserved in all the group. Decreased baroreflex sensitivity and increased sympathetic output in Sham were attenuated in ARDN group. Activity of GABAergic neurons in the NTS evaluated by immunostaining was increased in Sham compared to controls, and was attenuated in ARDN group. All of the changes in ARDN were cancelled in ARDN+BAROX group.

Conclusion:
Input from renal afferent nerves contributes to hypertensive heart failure with preserved systolic function through baroreflex impairment and sympathoexcitation along with increased GABAergic inhibition in the NTS.
Abstract 14971: Rate of 30-Day Readmission and Economic Burden of End-Stage Renal Disease Patients Who Underwent Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Procedure for ST - Elevation Myocardial Infarction
Authors: Fatuyi Michael , Alzamara Muayad , Akinti Oluwasegun , Aiwuyo Henry , Nworie Kenneth , bada funlola , ORIGBEMISOYE ADESINA , Coello Patrick , Illah Catherine , Amoah Joseph , Ayinalem Yonael , Brennan Emmett , Kahn Alexa
Published: December 2023

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

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

Results:
A total of 13,753 index hospitalization was observed with a mean age was 68.5 SD±12.9 years, and 60.4% of patients were males. The in-hospital mortality rate for index admission was 8.4% (1,153 of 13,753), while 30-DRr was 20.6% (2,596 of 12,600) (Figure 1). Among this group of readmitted patients (mean age was 66 SD±12.4 years, 59.6% of patients were males), the In-hospital mortality rate was 6.4% (166 of 2,596). However, observed 30-DRr among Non-ESRD patients was 9.02% (36,564 of 405,526), which is lower, as well as lower inpatient index and readmission mortality of 4.81% (19,507 of 405,426) and 4.83% (1,764 of 36,564) respectively. A healthcare economic burden of $214,000,000 among readmitted ESRD patients.

Conclusions:
Approximately 1 in 5 patients who underwent PCI and CABG procedure for STEMI with underlying ESRD had 30-DRr, with subsequent readmissions associated with healthcare spending. Readmission mortality was statistically lower than index mortality. ESRD patients are a vulnerable subset who will benefit from outpatient multidisciplinary care.
Abstract 14993: Empagliflozin Exerts a Sympathoinhibitory Effect and Ameliorates Cardiorenal Injuries in a Rat Model of Hypertensive Heart Failure
Authors: Matsumoto Sho , Shinohara Keisuke , Ikeda Shota , Kashihara Soichiro , Nakashima Ryosuke , Yoshida Daisuke , Yoshiyasu Ono , Nakashima Hiroka , Tsutsui Hiroyuki , Kinugawa Shintaro
Published: December 2023

Background:
SGLT2 inhibitors may have protective effects on cardiac and renal injuries; however, their mechanisms remain unclear. Sympathetic activation has a crucial role in cardio/renal injuries. This study aimed to investigate whether empagliflozin can inhibit cardio/renal injuries through sympathoinhibition in a rat model of hypertensive heart failure.

Methods:
Male Dahl salt-sensitive rats were divided into low-salt (LS) and high-salt (HS) diet groups from 6 weeks of age. The rats in HS group were assigned to vehicle (HS-VEH) or empagliflozin (HS-EMPA) treatment group at 8 weeks. The effect of empagliflozin on central sympathetic regulation and cardio/renal injuries was assessed at 12 weeks (pre-heart failure phase), while its protective effect on heart failure was evaluated at 15 weeks in another cohort.

Results:

At 12 weeks

, systolic blood pressure was similarly elevated in HS-VEH and HS-EMPA. Plasma norepinephrine levels were increased in HS-VEH compared to LS, and were suppressed in HS-EMPA, which was consistent with the neuronal activity of pre-sympathetic neurons in the brain. Increased left ventricular (LV) weight/body weight, plasma creatinine levels, renal fibrosis, and glomerular sclerosis in HS-VEH were attenuated in HS-EMPA.

At 15 weeks

, the high salt-induced blood pressure elevation was similar between HS-VEH and HS-EMPA. Although LV hypertrophy did not significantly differ, both decreased echocardiographic LV fractional shortening and increased lung weight observed in HS-VEH were attenuated in HS-EMPA. Elevated plasma creatinine and norepinephrine levels in HS-VEH were also attenuated in HS-EMPA.

Conclusion:
Empagliflozin inhibits sympathoexcitation and ameliorates cardio/renal injuries without lowering blood pressure in the hypertensive heart failure model. This sympathoinhibitory effect of empagliflozin observed in the pre-heart failure phase might contribute to the attenuation of heart failure progression.
Abstract 15000: Renal Denervation Improves Cardiac Function and Mitigates Pathophysiological Changes in a Novel Murine Model of Heart Failure With Preserved Ejection Fraction
Authors: Zhuqing Li , Lu Chengzhi
Published: December 2023

Introduction:
Heart Failure with Preserved Ejection Fraction (HFpEF) is a multifaceted disease, intricately linked with sympathetic nervous system activation. Despite advancements, therapeutic options for HFpEF remain constrained, largely due to a dearth of fitting preclinical models. Renal denervation (RDN), an emerging intervention, holds potential in attenuating sympathetic activity and ameliorating HFpEF high-risk factors such as hypertension and insulin resistance.

Aims:
our study is designed to establish a multifactorial HFpEF mouse model and assess the therapeutic implications of RDN.

Methods:
Aged 12-month-old male C57BL/6N mice were exposed to a high-fat diet (60% calories from lard) and L-NAME (0.5 g/L in drinking water) over a 5-week period to generate a multi-hit HFpEF model. The efficacy of the model was assessed through a range of methods, encompassing echocardiography, histology, exercise exhaustion tests, serum NT-proBNP measurements, and intraperitoneal glucose tolerance tests. Upon successful model establishment, mice were randomized to receive either bilateral renal denervation or a sham operation. The subsequent impact of RDN on the aforementioned parameters was then evaluated.

Results:
In C57BL/6N mice, a cardiometabolic HFpEF phenotype was effectively induced through a multi-hit approach encompassing a high-fat diet, L-NAME administration, and aging. This potent combination triggered obesity and glucose intolerance, culminating in the emergence of characteristic HFpEF features such as cardiac hypertrophy, fibrosis, preserved fractional shortening with impaired deformation, atrial enlargement, lung congestion, hypertension and decreased exercise endurance. Intervention with RDN mitigated this cardiometabolic dysregulation and enhanced cardiac function, as demonstrated by reductions in cardiac hypertrophy, myocardial fibrosis, atrial weight, NT-proBNP levels, lung congestion, and improved exercise endurance.

Conclusions:
Our study suggests that RDN effectively mitigates cardiac function and structure in a multi-hit HFpEF mouse model, indicating its potential as a promising therapeutic strategy for HFpEF.
Abstract 15007: Time to SGLT2i Initiation in Patients With Heart Failure
Authors: Moon Jungyeon , Udell Jacob A , Chong Alice , Fang Jiming , Austin Peter , Ko Dennis T , Stukel Therese , Atzema Clare , Booth Gillian , Tu Karen , Naimark David , Jackevicius Cynthia
Published: December 2023

Introduction:
SGLT2i, initially introduced as antidiabetic agents, have shown cardiovascular benefits for heart failure (HF) patients, irrespective of their diabetes status. Given the growing evidence from post-hoc analyses of landmark trials advocating for early initiation, this study aims to investigate the temporal trends in the timing of SGLT2i initiation after HF hospitalization.

Methods:
A cross-sectional study was conducted using administrative health data from Ontario, Canada. Our cohort included patients aged ≥65 years who filled an SGLT2i prescription after their HF hospitalization in Ontario, Canada between 4/2016-3/2021. We computed the median number of days to the first SGLT2i prescription after the HF discharge date, exclusively for patients who started SGLT2i. Patients were further stratified based on their diabetes status.

Results:
We identified 64,183 HF patients, of which 5,257 filled an SGLT2i prescription after discharge (mean age was 82.49; 46.9% men; 49.6% had diabetes). The number of patients starting an SGLT2i increased from 889 (16.9%) in 2016/17 to 1,206 (22.9%) by 2020/21. The median time from discharge following the index HF admission to first dispensation of an SGLT2i prescription decreased 7-fold over this period, from 1,082 days to 156 days (Figure 1). In 2016/17, patients with diabetes started an SGLT2i at a median of 930 days, and patients without diabetes at 1,640 days. However, by 2020/21, the median initiation times were closer at 143 and 189 days, respectively.

Conclusions:
Our findings demonstrate a substantial reduction in the time to SGLT2i initiation for patients after HF admission, suggesting increased clinician recognition of their cardiovascular benefits. However, initiation remains delayed, especially for patients without diabetes. To optimize patient outcomes, it is crucial to encourage early initiation of SGLT2i therapy in hospitalized HF patients and address potential barriers to SGLT2i initiation.