bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17028: Characteristics and Short-Term Outcome of Patients in the Program “Get With the Guidelines” - One Vietnamese Center Registry
Authors: VU NGA Q
Published: December 2023

Background:
“Get with the guidelines HF” is a program with the aim of properly applying heart failure treatment recommendations into clinical practice and improving the outcome of patients. This study evaluated the initial result of the implementation of the program in one Vietnamese center.

Method:
This is a prospective, one-center, observational registry in Hanoi Heart Hospital, Vietnam. Hospitalized heart failure patients over 18 years old with reduced and mild reduced left ventricular ejection fraction (LVEF) were enrolled. Data included demographic characteristics, comorbidities, discharge medications, and post-discharge appointment plans.

Results:
From September 2021 to December 2022, 749 patients were included in the study with a mean age of 65. The male and female ratio was 56.1% and 43.9% respectively. 65.3% of the patients had reduced LVEF and 34.7% had mild reduced LVEF. Coronary heart disease was the most popular comorbidity and was diagnosed in 44.6% of patients. At discharge, after excluding drug contraindications, the rate of prescribing of RASi drugs (ACEi, ARB or ARNI), beta-blocker, mineralocorticoid receptor antagonists (MRA), SGLT2i were 97.56%, 92.86%, 96.15%, 57.14%, respectively in Q4.2021. At discharge, the rate of using these 4 drugs in Q4.2022 was 99.15%, 100%, 100%, and 85.19%, respectively. The rate of patients receiving all 4 GDMT drugs according to ACC/AHA guidelines in Q4.2021 and Q4 2022 was 28.8% và 41.4%. The percentage of patients using 3 and 2 GDMT drugs in the times mentioned above was 33.3% and 35.4% and 24.2% and 14.8%, respectively. Short-term follow-up showed that 30-day re-admission was 2.94% and the 30-day mortality after discharge was 0%.

Conclusion:
“Get with the guidelines” helps to implement guidelines to daily practice, especially the use of GDMT drugs, and gives promising results to improve the outcome for patients with heart failure. Keywords: heart failure, GDMT, Get with the guideline
Abstract 17034: Outpatient Effort to Improve Medication Uptitration and Maintenance (OPTIMUM)
Authors: Xac May , Chidester Jeffrey P , Hulet Leiandie , Kelly Megan , Moss Elizabeth , Chang Christina , Jones Jennifer , Della-Penna Paige , Amin Alpesh , Hendren Nicholas , Das Sandeep R
Published: December 2023

Introduction:
Guideline-directed medical therapy (GDMT) reduces morbidity and mortality for patients with heart failure with reduced ejection fraction (HFrEF) starting as early as 30-days from initiation. Rapid GDMT titration programs have been shown to be effective in clinical trials. We evaluated the feasibility of a rapid GDMT clinical program in a safety-net population with HFrEF.

Methods:
Patients admitted to a large urban safety net hospital with newly diagnosed HFrEF (LVEF <40%) were eligible for the program. Patients with end-stage renal disease, history of cardiogenic shock, or current homelessness were excluded. The 6-week program consisted of alternating in-person heart failure clinic visits and virtual visits with a multidisciplinary team of pharmacists, nurses, and physicians to adjust medications and to provide heart failure education. Intensities of GDMT prescription at the start of the program and at 3 months were compared using an institutional GDMT score ranging from 0-11 which accounts for drug classes (beta-blocker, ACE/ARB/ARNI, MRA, SGLT2i) and percent of target doses prescribed (Figure, panel A).

Results:
This pilot enrolled 20 patients (mean age 58.0 +/- 15.6 years, 35% women, 25% Black, 75% Hispanic). At enrollment, patients had an average GDMT score of 5.5 on 2.9 classes of GDMT. At week 6, 15 (75%) patients were prescribed all 4 classes of GDMT with a 2.7 increase in the GDMT score for an average score of 8.2 (Figure, panel B).This was sustained at 3 months. There were no safety events requiring ED visits or hospitalization during the program duration.

Conclusions:
In a safety-net health system caring for the urban poor, rapid GDMT up titration was feasible and resulted in increased GDMT intensity without clinical adverse events. Our experience supports the development of rapid GDMT titration programs even in clinical settings and patient populations which differ from those enrolled in clinical trials.
Abstract 17042: Altered Myocardial Energy Substrate Utilization in Metabolic Syndrome May Impact Pathways Involved in Contractile Dysfunction in Ischemic Myocardium
Authors: Banerjee Debolina , Stanley Madigan , Sellke Frank W , Usheva Anny
Published: December 2023

Introduction:
Metabolic syndrome (MetS) is increasingly prevalent and an independent risk factor for ischemic heart disease (IHD). MetS favors lipids over glucose as the predominant myocardial energy substrate. Similarly, in IHD, energy utilization is dependent on ketone bodies. Evidence is emerging that such changes in cardiac energy metabolism may drive contractile dysfunction, but the underlying processes have not been clarified in the context of coincident MetS and ischemia.

Aims:
The purpose of this multiomics study was to define the global metabolic state of ischemic myocardium in the setting of MetS, with a focus on energy metabolism and pathways modulating myocardial function and contractility. We hypothesized MetS would further shift substrate utilization away from glycolysis to favor ketone bodies, contributing to pathways of contractile dysfunction in injured myocardium.

Methods:
We used our well-established porcine model of diet-induced MetS and chronic myocardial ischemia to study effects on left ventricular tissue. Tissue samples from MetS swine and controls were analyzed using targeted LC-MS/MS for polar metabolites, RNA-seq, proteomics, and computational nonnegative matrix factorization.

Results:
MetS swine had altered bioavailability of 302 polar metabolites together with changes in gene expression of enzymes involved in glycolysis, fatty acid metabolism, ketone body utilization, and abnormal activation of renin-angiotensin-aldosterone system (RAAS). MetS swine also had reduced expression of Apelin protein, a potent stimulator of cardiac contractility (Figure).

Conclusions:
Our data show MetS enzymatically downregulates glycolysis and upregulates ketone body utilization together with derangement in RAAS in injured myocardium. Decreased Apelin expression may contribute to lipid-induced cardiac dysfunction through maladaptive effects on contractility and remodeling, and thus may serve as a future therapeutic target.
Abstract 17056: Hierarchical Clustering of ‘Inflammaging’ Markers Reveals Pro-Inflammatory Cytokines to Associate With Outcome Independent of Chronologic Age After TAVR
Authors: Zanders Lukas , Mas-Peiro Silvia , Berkowitsch Alexander , Tombor Lukas , Rasper Tina , Leistner David M , Dimmeler Stefanie , Zeiher Andreas M
Published: December 2023

Background:
Aortic valve stenosis (AVS) is an age-related disease lacking effective causal therapies. Aging is linked to cellular senescence, which leads to the secretion of the “senescence-associated secretory phenotype” (SASP). Recent evidence suggests a connection between AVS and SASP expression.

Aim:
The study aimed to assess expression patterns and the prognostic impact of SASP components in patients undergoing transcatheter valve replacement (TAVR) for severe AVS.

Methods:
We analyzed 12 SASP components in plasma from 320 patients undergoing TAVR between February 2017 and September 2021, using the Luminex® Assay (Bio-Techne, Germany). Follow-Up was conducted up to 3 years after TAVR with all-cause mortality as the primary endpoint. Hierarchical clustering was performed to identify patterns of SASP expression, and clusters were analyzed for their impact on survival, associations with age and frailty of patients. Significant covariates (p<0.1), as identified by univariate regression, were included in the AFT model for survival analyses.

Results:
The patients’ median age was 83.2 years (95%CI 82.4 - 83.9), with 39.7% being female. Hierarchical clustering revealed 3 main clusters, characterized by circulating concentrations of pro-inflammatory cytokines (Fig. A). Clusters with higher levels of pro-inflammatory SASP components showed worse survival after adjusting for covariates (COPD, previous stroke, NYHA class, eGFR, anemia) (Fig. B). Patients’ age did not differ between clusters, but those in clusters with higher levels of pro-inflammatory markers were more likely to be frail (Fig. C).

Conclusion:
In elderly patients undergoing TAVR for severe AVS, pro-inflammatory SASP components are associated with worse survival, independent of chronologic age. These findings suggest a role of cellular senescence and markers of ‘inflammaging’ in outcomes of patients with AVS and might also enhance risk stratification in patients with AVS undergoing TAVR.
Abstract 17062: Disparities in Cardiovascular Mortality Among Disaggregated Asian Groups: Results From the 1999-2018 National Health Interview Survey
Authors: Bacong Adrian M , Rivera Frederick B , Priela Lia Veronique
Published: December 2023

Background:
Asian people generally have lower cardiovascular (CVD) morbidity and mortality relative to other race and ethnic groups. However, few studies have examined differences in CVD mortality among disaggregated Asian groups. Additionally, mortality data often lack comprehensive information on social and socioeconomic factors which could contribute to differences in mortality by race.

Methods:
Using the 1999-2018 National Health Interview Survey linked to the National Death Index, we examined cardiovascular (CVD) mortality among Asian Indian (N=4,660), Chinese (N=4,823), Filipino (N=4,835), and Other Asian (e.g., Korean, Japanese, Vietnamese, N=8,472) and Non-Hispanic White adults (N=312,850). We examined 5 nested multivariable Poisson regression models comparing CVD mortality of disaggregated Asian groups accounting for demographic, social, and socioeconomic factors, and body mass index (BMI).

Results:
There were vast differences in CVD mortality by 2018 follow up and participant characteristics by race and ethnicity. CVD mortality was lower among each disaggregated Asian ethnic group relative to Non-Hispanic White people (Table). Asian Indians were lowest (IRR = 0.19, 95% CI = 0.11, 0.30), followed by Chinese (IRR = 0.33, 95% CI = 0.24, 0.46), then Filipino (IRR = 0.46, 95% CI = 0.36, 0.60) and Other Asian (IRR = 0.54, 95% CI = 0.43, 0.69). This advantage remained when adjusting for age and sex, social factors, socioeconomic status, and BMI for all Asian groups except for Other Asians.

Conclusions:
Asian people have a CVD mortality advantage compared to Non-Hispanic White people. Demographic, social, and socioeconomic factors, and BMI accounted for some, but not all of the differences in CVD mortality among Asian groups compared to Non-Hispanic White people. Future epidemiological study should focus on the social and environmental factors that promote health among Asian groups.
Abstract 17063: Pericardial Patch Augmentation of the Anterior and Posterior Tricuspid Leaflets Relieves Leaflet Tethering and Improves Coaptation in an Acute Porcine Model
Authors: Rando Hannah , Quinn Rachael W , Lester Laeben , Darby Zachary , Chinedozi Ifeanyi , Kang Jin Kook , Gammie James S
Published: December 2023

Background:
Tricuspid annuloplasty is generally effective in treating functional tricuspid regurgitation (TR), but patients with severe annular dilation or leaflet tethering have a high risk of recurrence.

Hypothesis:
We hypothesized that anterior and posterior patch augmentation (APA) of the tricuspid valve (TV) would reduce leaflet tethering, improve coaptation, and effectively treat TR.

Methods:
We evaluated APA repair in an acute porcine model. The TV was accessed via a right thoracotomy and cardiopulmonary bypass (CPB) was initiated with bicaval venous and ascending aortic cannulation. The anterior and posterior TV leaflets were separated from the annulus, and a 1.5 cm wide partial reverse frustum-shaped pericardial patch was implanted. 3D transepicardial echocardiography was used to image the TV pre- and post-implantation. Geometric measurements were assessed using Tomtec and compared with paired t-tests.

Results:
APA repair was performed in five pigs (weight 60-80 kg). All animals were weaned from CPB in sinus rhythm. TR was trace or absent in all cases after APA repair. There were no changes in pressure gradient (0.5 vs 0.5, p>0.9) or annular area (11.2 vs 10.1 cm
2
, p=0.19). APA repair was associated with a decreased tenting height and angle of the anterior (height: 9.0 vs 4.6 mm, p=0.03; angle: 20.9° vs 16.1°, p=0.04) and posterior (height: 9.8 vs 5.5 mm, p=0.03; angle: 28.1° vs 21.8°, p=0.03) leaflets. Central coaptation length increased in all leaflets (septal: 3.8 vs 6.6 mm, p=0.04, anterior: 4.7 vs 12.7 mm, p<0.01, posterior: 4.5 vs 13.2 mm, p<0.01).

Conclusions:
APA repair was feasible, safe, reduced leaflet tenting, and improved coaptation. This novel repair method shows promise for patients with severe annular dilation or leaflet tethering who otherwise have a high risk of recurrence with annuloplasty alone. Furthermore, by avoiding suture placement near the conduction system, it may reduce the risk of post-operative conduction abnormalities.
Abstract 17066: Efficacy and Safety of the Pharmacoinvasive Strategy Compared With Primary Percutaneous Coronary Intervention in Patients Initially Presenting to Hospital Centers Without Capacity for Coronary Intervention
Authors: Robles-Ledesma Mariana , Najera-Rojas Nitzha Andrea , Ezquerra Osorio Alejandro , Alonso-Bringas Alma Paola , Sánchez-Leony Giovanna , Gopar-Nieto Rodrigo , Sierra Lara Martinez Jorge Daniel , Arias-Mendoza Alexandra , Araiza Diego
Published: December 2023

Introduction:
Primary PCI (pPCI) is the preferred treatment for reperfusion in STEMI patients. However, its feasibility in real-world scenarios raises questions about the effectiveness of the pharmacoinvasive strategy compared to pPCI for patients arriving at a healthcare facility without a catheterization laboratory.
Hypothesis
:
A pharmacoinvasive strategy is more effective than transferring STEMI patients to a PCI-equipped hospital for those initially presenting to non-PCI centers.

Aims:
To compare the efficacy of the pharmacoinvasive strategy versus referral for primary PCI in STEMI patients initially presenting at non-PCI centers.

Methods:
This study is a pre-specified subanalysis of the PHASE-Mx registry (NCT NCT03974581), including consecutive STEMI patients from Mexico City treated within 12 hours of symptom onset. Patients received either the pharmacoinvasive strategy or were referred for pPCI. The primary composite endpoint was cardiovascular death, cardiogenic shock, recurrent myocardial infarction, or congestive heart failure at 30-day follow-up.

Results:
A total of 634 patients were included, with 61.3% treated with the pharmacoinvasive strategy and 38.6% referred for pPCI. Mean age was 58.3 (+/-10 years), and the majority were men (85.3%). Compared to those transferred for pPCI, pharmacoinvasive strategy showed a significant reduction in the risk of the primary endpoint beyond 30 days, with a hazard ratio (HR) of 0.60 (95% CI 0.39-0.94, p = 0.02). This risk reduction was primarily driven by a significant decrease in heart failure risk (HR 0.57, 95% CI 0.35-0.93, p = 0.025).

Conclusions:
Pharmacoinvasive strategy in STEMI patients initially attending hospitals without PCI capability resulted in a 40% risk reduction for cardiovascular death, heart failure, cardiogenic shock, and recurrent infarction at 30-day follow-up compared to referral for pPCI.
Abstract 17081: Targeted Proteomics Identifies Circulating Biomarkers Associated With Biological Sex in Dilated Cardiomyopathy
Authors: Tayal Upasana , Januzzi James L , Halliday Brian , Lota Amrit S , Ware James S , Pennell Dudley , Prasad Sanjay K
Published: December 2023

Background:
The pathophysiology underlying sex specific differences in dilated cardiomyopathy (DCM) is incompletely understood. Targeted proteomic discovery enables quantification of low abundance circulating proteins to elucidate mechanisms of disease.

Hypothesis:
Female sex is associated with a distinct biomarker profile that confers insights into DCM pathogenesis.

Aim:
Evaluate the biomarker profile associated with biological sex in dilated cardiomyopathy.

Methods:
Cross sectional analysis of 490 patients with dilated cardiomyopathy confirmed by cardiovascular magnetic resonance imaging. Targeted proteomic analysis was performed with proximity extension assays to determine sex differential expression of 276 proteins associated with inflammation or cardiovascular disease. Expression was compared between males and females.

Results:
A third of patients were female (n=160, 33%). After adjusting for false discovery, 10 proteins were significantly upregulated and 8 were significantly downregulated in female compared to male patients (A Inflammatory panel, B Cardiovascular panel). These were grouped into 3 clusters (C), enriched for cytokine pathways (red), regulators of cardiac function (green), and markers of fat metabolism (blue). Of the sex differentially expressed proteins, GDF2 (regulates angiogenesis), protein BOC (augments cardiac tissue repair) and CD5 (linked to inflammation) were top determinants of biological sex after adjusting for age, renal function, body mass, and cardiac function (D).

Conclusion:
Sex specific proteomic signatures provide new insights into the pathophysiology underlying sex differences in DCM. Figure: Volcano plots showing log2 fold change in protein expression in inflammatory (A) and cardiovascular (B) proteins. Blue = lower and red = higher levels in females. Protein interactions shown in C. Top predictive feature of sex is body surface area, followed by biomarkers GDF2 and Protein BOC, shown in D.
Abstract 17083: Aortic Luminal Contrast Attenuation Varies With Dissection Morphology and is Associated With Need For Intervention
Authors: Feldman Zachary M , Sumpio Brandon J , Lee Sujin , Sabatino Marlena , DeCarlo Charles C , Fedrigoni Thomas , Srivastava Sunita , Eagleton Matthew , Mohebali Jahan
Published: December 2023

Introduction:
Prognostication after acute Type B aortic dissection (aTBAD) may be limited when relying upon static computed tomographic angiography (CTA) images to evaluate a dynamic process. We performed an exploratory study to characterize variations in luminal contrast attenuation on CTA, as a surrogate for blood flow in dissection, and to determine whether the resulting parameters held prognostic value.

Methods:
Retrospective, single-institution data for patients with aTBAD were gathered from 1999-2020. Patients with prior dissection repairs were excluded. Dissection morphology was classified by the SVS/STS scheme and location/number of fenestrations. Hounsfield unit ratios (HUR) comparing lumina, phases, and aortic zone were calculated. Aortic growth, false lumen thrombosis, and need for intervention were evaluated with univariable logistic regression.

Results:
After exclusions, 85 patients were identified (mean age 61.9 years, 69.4% male). SVS/STS B
3,10
(20%) and B
3,5
(12.9%) predominated (Figure). Most fenestrations were in Zone 4/5 (56.5%) and associated with more equilibrated HUR (0.93) compared to dissections without fenestration (0.70,
p
= 0.04). Fenestration zone was not associated with HUR (
p
= 0.59). Intervention occurred in 65.9%, most often for aneurysmal degeneration (43.8%), followed by visceral/limb ischemia (32.6%). Growth occurred in 28.2%. Increased arterial false-to-true HUR was strongly associated with eventual need for intervention (OR 25.3 [95% CI 4.15-188.4],
p
= 0.001) while increased delayed-to-arterial false lumen HUR was associated with decreased intervention (OR 0.49 [95% CI 0.25-0.89],
p
= 0.02).

Conclusion:
In patients with aTBAD, calculated permutations of HUR across lumina and between CTA phases may give insight into blood flow dynamics, which in turn likely impact need for intervention. Future prospective studies of time-resolved CTA are likely to hold significant prognostic value and alter management.
Abstract 17093: The 3D T-Tubule Network Significantly Remodels in Cardiomyocytes Subjected to Mechanical Load
Authors: Song Leo , Courelli Vasiliki , Vite Alexia , Prosser Benjamin , Margulies Kenneth B , Ibrahim Michael
Published: December 2023

Introduction:
T-tubules (TT) are critical for excitation-contraction coupling in cardiomyocytes (CMs). Past work studying heart failure has spatially localized TT loss with inhibited Ca2+ release in the 2D space. This limited view does not consider tubules in other z-planes, necessitating a 3D understanding of the network.

Hypothesis:
We hypothesize that the ultrastructure of the 3D TT network significantly remodels in response to increase in culture substrate stiffness.

Methods:
Adult rat ventricular CMs were cultured ex vivo on substrate with either physiological stiffness (10 kPa) or pathological stiffness (50 kPa) for 2 days. Live CMs were stained for TTs (Di-8-ANEPPS) and Ca2+ (Fluo-4). 3D renderings of the TT network were reconstructed from z-stacks of 2D confocal images in the Arivis software. Within a set 3D region of interest, orientation (longitudinal, transverse, axial), volume, and surface area of tubules were measured. Ca2+ transients were taken from a line scan. Data from 18 CMs cultured at 10 kPa and 15 CMs cultured at 50 kPa were acquired.

Results:
CMs cultured on 50 kPa surfaces exhibited a decrease in the number of transverse elements (147 to 112) and an increase for longitudinal elements (3 to 16) compared to control CMs cultured on 10 kPa surfaces. For all 3 orientations, the volume of the average tubule increased by at least 20% following culture on 50 kPa surfaces. The total surface area of all axial and longitudinal tubules increased by at least 130% and decreased by 13% for all transverse tubules following culture on 50 kPa surfaces.

Conclusions:
Two days of culture on stiffened surfaces, designed to mimic the stiffness of diseased hearts, produces significant TT remodeling. Our work suggests that the remodeled TT network has less spatial capacity to release Ca2+ and worsened access to actin-myosin sites. In the future, we will associate the distance between each pixel on the line scan to the nearest TT with Ca2+ release parameters. This model system will permit further elucidation of how particular aspects of TT remodeling affect Ca2+ release and will facilitate testing of therapeutic interventions designed to prevent load-dependent defects in excitation-contraction coupling.
Abstract 17094: An Ensemble Deep Learning Model to Automate Screening For Multiple Structural Heart Diseases on 12-Lead Electrocardiograms
Authors: Dhingra Lovedeep S , Aminorroaya Arya , Khunte Akshay , Sangha Veer , Sen Sounok , Haynes Norrisa , Krumholz Harlan M , Khera Rohan
Published: December 2023

Introduction:
As echocardiographic screening is limited by access to technology, structural heart disease (SHD) is often diagnosed after the development of clinical symptoms. To enable automated and accessible screening of SHD, we developed and validated a deep-learning model for 12-lead electrocardiograms (ECGs) for various screening populations.

Methods:
We used 12-lead ECGs with paired TTEs at the Yale New Haven Hospital (2015-2021) to develop convolutional neural networks for detecting SHD. SHD was defined as the presence of any one of the following on a transthoracic echocardiogram (TTE) performed within 30 days of the ECG: hypertrophic cardiomyopathy (IVSd > 1.5cm and diastolic dysfunction), LV ejection fraction < 40%, or severe left-sided valvular disease (aortic/mitral stenosis or regurgitation). We developed an ensemble XGBoost model based on predictions for individual SHDs and patient age and sex as a single screen across all SHDs. We also simulated the model performance across cohorts with varying disease prevalence.

Results:
The model was developed in 456,927 ECGs/118,623 individuals (66.5±16.0 years, 45.6% women, 16.5% Black) and validated in 13,181 ECGs/13,181 individuals (65.1±17.3 years, 49.5% women, 14.5% Black). In the held-out validation set, the ensemble XGBoost model achieved an AUROC of 0.92 (95% CI: 0.91-0.94) and an AUPRC of 0.64 (95% CI: 0.57-0.70), with a sensitivity of 85% and specificity of 88%. The AUROCs for the individual disease models ranged from 0.72-0.95. (Panel A) In the test set with 10% disease prevalence, the ensemble model had a PPV 44% and an NPV of 98%. (Panel B) In simulated cohorts with 5% and 20% disease prevalence, the model had reached NPV & PPV of 99% & 27%, and 98% & 64%, respectively. (Panel C)

Conclusion:
We developed a novel ensemble deep-learning model for detecting several SHDs directly from ECGs with high PPV and NPV. This approach represents a robust, scalable, and accessible modality for automated SHD screening.
Abstract 17098: Detection of Multiple Structural Heart Diseases Using a Novel Artificial Intelligence-Driven Algorithm for Noisy Real-World Single-Lead ECGs
Authors: Aminorroaya Arya , Khunte Akshay , Dhingra Lovedeep S , Sangha Veer , Sen Sounok , Haynes Norrisa , Krumholz Harlan M , Khera Rohan
Published: December 2023

Background:
Wearable devices capable of ECG acquisition can help scale screening of structural heart disease (SHD) if diagnoses can be made with a single lead ECG. Algorithms for portable and wearable ECG require resilience to noisy acquisition but can enable detecting SHD in a community setting before symptom onset, ideal for public health management.

Methods:
Using Yale EHR data (2015-2021), we developed an artificial intelligence model to detect the presence of left ventricular systolic dysfunction, severe left-sided valvular disease, or hypertrophic cardiomyopathy using lead I of an ECG, which is commonly captured by wearable devices. We used 563,668 ECGs paired with echocardiograms obtained within 30 days of each other from 131,804 patients to develop the model. The dataset was split into training, validation, and test sets (85:5:10). For individual disease labels, we trained 6 convolutional neural network models using ECG signals augmented with random Gaussian real-world noise within 4 distinct frequency ranges and at 4 signal-to-noise ratios. Then, we included their prediction probabilities and age and sex as inputs to an XGBoost model to predict the composite SHD (Fig).

Results:
In the development set, the prevalence of composite SHD was 13%, encompassing left ventricular systolic dysfunction (9%), severe valvular disease (4%), and hypertrophic cardiomyopathy (1%). In the held-out test set of 13,181 patients (65±17 years, 49% women, 14% Black), AUROC and AUPRC of the ensemble model for prediction of SHD were 0.92 (0.90-0.93) and 0.61 (0.54-0.68), respectively (Fig). With optimized Youden's index, the model has a sensitivity of 0.83, specificity of 0.87, PPV of 0.41, and NPV of 0.98 to detect SHD.

Conclusion:
A novel wearable-adapted model demonstrated promising performance for detecting multiple SHD using single-lead ECG. This can enable community screening for SHD and improve patient outcomes through early initiation of guideline-directed therapies.
Abstract 17100: Evaluating Chatgpt Responses on Atrial Fibrillation for Patient Education
Authors: Lee Thomas J , Campbell Daniel J , Elkattawy Omar , Viswanathan Rohan
Published: December 2023

Introduction:
ChatGPT is an artificial intelligence (AI) chatbot released in November 2022. It is a large scale language model that has gained widespread popularity for its fine-tuned conversational abilities, attracting over 1.8 billion monthly visitors. A noted drawback to the AI chatbot is its tendency to confidently present users with inaccurate information.
Goals:
To evaluate the quality of ChatGPT responses to questions pertaining to atrial fibrillation for patient education. This includes the accuracy of answers, estimated grade level, and references of answers.

Methods:
ChatGPT was prompted four times then was asked 16 questions derived from the American Heart Association's frequently asked questions on atrial fibrillation. Prompts included: no prompt (Form 1), patient-friendly prompt (Form 2), physician-level prompt (Form 3), and prompting for statistics/references (Form 4). Responses were scored as incorrect, partially correct, correct, or correct with references (perfect). Flesch-Kincaid grade level and response lengths were recorded. Proportions of responses at differing scores were compared using chi-squared analysis. The relationship between form and grade level was assessed using ANOVA.

Results:
Across all forms scoring frequencies were: 1(1.6%) incorrect, 5 (7.8%) partially correct, 55 (85.9%) correct, and 3 (4.7%) perfect. Proportions of responses that were at least correct did not differ by form (p=0.350); responses that were perfect did (p<0.001). Form 2 answers had a lower mean grade level (12.81 ± 3.38) than Forms 1 (14.23 ± 2.34), 3 (16.73 ± 2.65), and 4 (14.85 ± 2.76) (p<0.01).

Conclusions:
ChatGPT provides accurate and comprehensive answers to most questions about atrial fibrillation regardless of prompting. Interestingly, when prompted as a patient, ChatGPT will provide lower grade level responses. Given ChatGPTs rapid popularity and usage, cardiologists may seek to further investigate its accuracy and utility for patients.
Abstract 17106: Comparing Pre- and Post- Pandemic Personal Health Monitoring Using Wearable Devices in United States Adults With or at Risk for Cardiovascular Disease: A Nationally Representative Study
Authors: Dhingra Lovedeep S , Aminorroaya Arya , Oikonomou Evangelos K , Sangha Veer , Krumholz Harlan M , Khera Rohan
Published: December 2023

Introduction:
The COVID-19 pandemic represented a major global health crisis that potentially refocused public attention on personal health monitoring. We evaluated changes in personal health monitoring using wearable devices, before and after the pandemic.

Methods:
To evaluate the changes in self-reported use of wearables pre- and post-pandemic, we used the nationally representative Health Information National Trends Survey (HINTS) study for Jan 2019 through Feb 2020 (pre-pandemic) and 2022 (post-pandemic). We assessed use in individuals with cardiovascular disease (CVD), and CV risk factors (hypertension, diabetes, smoking, obesity), accounting for the complex survey design. We also examined the interaction of sociodemographic features with the pandemic, for wearable use, using survey logistic regression.

Results:
Of the 15,555 individuals in HINTS, 10,262 (60 ± 16 years, 57% women) had CVD or risk factors. There was a 28% increase in wearable use in the overall population and 27% in adults with CVD or risk factors. An estimated 48.7 (43.9-53.4) million adults with CVD or risk factors (31% [29-34] of all adults with CVD or risk factors) reported using wearable devices post-pandemic, compared with 38.1 (34.7-41.5) million (25% [23-27]) pre-pandemic. In adults with CVD or risk factors, wearable use increased among all sociodemographic subgroups. (Fig) The pandemic was independently associated with increased use of wearables (OR 1.42 [1.24-1.63]). However, there was no significant interaction between the pandemic and sociodemographic subgroups (all P > 0.05).

Conclusion:
The use of wearable devices increased across sociodemographic subgroups in adults with or at risk for CVD. However, the uptake was not disproportionately greater in subgroups with known worse health outcomes. Despite the increased awareness for health monitoring during the pandemic, inequities in use of wearable health technology continue to threaten disparities in patient outcomes.
Abstract 17124: Comparative Outcomes of Below-the-Knee Atherectomy Interventions: A Report From the XLPAD Registry
Authors: Weideman Sarah , Fernandez Vazquez David , Bruneman Blake , Nanjundappa Aravinda , Metzger Christopher , sayfo sameh , Rosol Zachary , Tsai Shirling , Shishehbor Mehdi H , Banerjee Subhash
Published: December 2023

Background:
Atherectomy devices are used during below-the-knee (BTK) artery interventions to tackle the calcium burden in peripheral arteries.

Methods:
We examined 1542 patients from the XLPAD Registry (NCT01904851) from 2006-2021 who underwent BTK endovascular intervention, stratified by use of atherectomy device or not. The primary outcome was the incidence of major adverse limb events (MALE), a composite of all-cause death, clinically driven revascularization, amputation, non-fatal myocardial infarction (MI), and stroke.

Results:
710 (46%) patients were treated with an atherectomy device and 832 were not. Mean age 68 years, predominantly male (72%) and Caucasian (58%). Cardiovascular risk factors were equally distributed among both groups, except hyperlipidemia was more prevalent in the atherectomy group (83% vs. 78%, p=0.01). Both groups had similar Ankle-Brachial Indexes. Atherectomy group had more multivessel interventions (2.5 vs 1.9 lesions per case, p<0.001) and SFA (54% vs. 38%, p<0.001) and popliteal artery (31% vs. 26%, p<0.001). Exclusive BTK interventions were evenly distributed between the groups. Atherectomy patients had greater calcification burden (32% vs 21%, p<0.001), diffuse disease (58% vs. 47%, p<0.001) and in-stent restenosis (9% vs. 4%, p<0.001). Stents and conventional balloon use were evenly distributed, but atherectomy patients received more drug-coated balloon treatments (10% vs 7%, p=0.04). Fluoroscopy time was longer in atherectomy group (33 min vs. 30 min, p= 0.04) with higher rates of procedural (94% vs. 91%, p=0.01) and technical success (98% vs. 93%, p<0.001). Only 30-day rate of amputation was higher among non-atherectomy patients (2% vs. 6%, p<0.001). There were no differences in the MALE (24% vs. 22%, p=NS), only surgical revascularization at 12-month follow-up more frequent in the non-atherectomy group (1% vs. 2%, p=0.01).

Conclusion:
Atherectomy use is high at 46% of all BTK artery interventions in the XLPAD Registry with higher technical success than non-atherectomy interventions without differences in MALE events at 12-month follow-up.
Abstract 17152: Use and Outcomes of the Medical Hybrid Procedure for Stage 1 Palliation in Infants With Hypoplastic Left Heart Syndrome and Variants
Authors: Beauchamp Daniel N , Statile Christopher J , Zang Huaiyu , Parra David A , Godown Justin A , Jayaram Natalie M , Moehlmann Matthew L , Hill Garick D
Published: December 2023

Background:
Staged palliation of hypoplastic left heart syndrome (HLHS) and variants typically begins with the Norwood operation or the hybrid procedure. Hybrid palliation is used in 13% of patients nationally and is often reserved for high-risk patients. A stented hybrid (SH) consists of bilateral pulmonary artery bands (bPAB) and a ductal stent while a ‘medical hybrid’ (MH) consists of bPAB and prostaglandins. MH use and outcomes have not been well described.

Hypothesis:
MH is used in higher-risk patients and therefore has lower survival than other stage 1 strategies.

Aims:
Compare use and outcomes of MH, SH, and surgical stage 1 (SS1) using a multicenter database.

Methods:
Patients from the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) database were categorized by initial intervention: MH, SH, or SS1. Other/unclear procedures were excluded.

Results:
The study included 2423 patients from 65 centers: 277 (11%) MH, 133 (5%) SH, 2013 (83%) SS1. MH had the lowest birth weight (BW) and gestational age (GA), most non-cardiac anomalies, and most preoperative risk factors (PRF). Most centers performed MH in a minority of cases, though use ranged from 0% to 82% at centers with ≥10 patients. Transplant-free survival at 1 year was 56% for MH, 66% for SH, and 81% for SS1 (p<0.0001). Using multivariable logistic regression, predictors of MH vs SS1 were lower BW (p<0.001), lower GA (p<0.001), genetic syndrome (p=0.010), non-cardiac anomaly (p=0.031), and ≥4/12 PRF (p<0.001). Predictors of MH vs SH were HLHS (p=0.044) and ≥4/12 PRF (p=0.045). Cox proportional hazards regression was used to compare risk-adjusted outcomes, excluding one center that performed >50% SH: MH had higher risk of one-year mortality/transplant compared to SS1 (HR = 1.89, 95% CI 1.47-2.42) and no difference compared to SH (HR = 1.16, 95% CI 0.76-1.79).

Conclusions:
Survival after MH is similar to SH and worse than SS1. This may be due to patient risk factors not controlled for in this study.
Abstract 17153: Mitochondrial Cx43 and Gja1-20k Contribute to Sex-Specific Differences of Mitochondrial Response in Septic Cardiomyopathy
Authors: Anjorin Olufisayo , Scott Susan R , Turrentine Mark , Wang Meijing
Published: December 2023

Introduction:
Cardiac dysfunction contributes to morbidity and mortality of severe sepsis. Preserving mitochondrial (mito) activity is key to maintaining cardiac function. While epidemiological studies consistently report that male sex is an important risk factor for severe sepsis, it is unknown if male heart mito are susceptible to septic injury. We have shown that male cardiomyocyte mito were more vulnerable to TNFα- or H
2
O
2
-induced stress than females. We have also demonstrated that mito connexin 43 (Cx43 or Gja1) and its smaller isoform - Gja1-20k are implicated in sex-related heart response following myocardial ischemia.
Hypothesis
:
In this study, we hypothesize that during sepsis, female (F) hearts exhibit preserved mito Cx43 and Gja1-20k to confer mitochondrial protection, thus improving cardiac function compared to male (M) myocardium.

Methods:
Age-matched adult M & F C57BL/6 mice received LPS (7.5 mg/kg BW, i.p.) or PBS (n > 6 mice/group). Cardiac function was detected 20h post LPS by 2D echocardiography. Cx43, Gja1-20k, OXPHOS, & PGC-1 were evaluated in M & F mouse heart mito 24h after LPS by Western Blot (n>3 hearts/group). Mito Cx43 was also detected by Immuno-electron microscopy (EM). Mito membrane potential (ΔΨm) was analyzed in cardiomyocytes (from adult M & F mice, n>3 hearts/group) +/- 1h LPS (1 μg/ml) using JC1 fluorescent probe. Mito respiration capacity was further assessed in H9c2 cells transfected with Gja1 siRNA upon LPS exposure by Seahorse XF Mito Stress test.

Results:
Decreased cardiac function was observed in M mice after LPS injection, but not in F. Higher mito levels of Cx43, Gja1-20k, OXPHOS, & PGC1 were noticed in F mouse hearts compared to M after LPS. Despite no difference in total Cx43 particles between M & F hearts by EM, more gold Cx43 particles were observed in F heart mito compared to M mito following LPS. LPS reduced ΔΨm in M cardiomyocytes, but not in F. Cx43 knockdown decreased mito maximal respiration capacity & ATP production in H9c2 cells with LPS stress.

Conclusions:
The mitochondria-derived protective mechanism is preserved in F mice, leading to better cardiac function than M mice following LPS-induced sepsis. F cardiac mito are more resistant to LPS challenge than M mito, partially due to preserved mito Cx43 and/or Gja1-20k.
Abstract 17162: High Lp(a) is Associated With Activation of the Arachidonic Acid Pathway
Authors: Malick Waqas , Mar Phyu , Goonewardena Sascha N , Rosenson Robert S
Published: December 2023

Introduction:
High lipoprotein(a) [Lp(a)] is associated with increased platelet aggregation, inflammation and cardiovascular events. Eicosanoids such as eicosapentaenoic acid (EPA) and arachidonic acid (AA) have anti- and pro-inflammatory effects, respectively. In this cross-sectional study, we explored the associations between eicosanoids, Lp(a), and oxidized phospholipids on apolipoprotein B (oxPL:apoB).

Hypothesis:
Increased platelet aggregation and inflammation associated with high Lp(a) levels may be due to relative EPA and AA levels.

Methods:
Consecutive outpatients with known Lp(a) levels seen in an outpatient cardiology practice between April 2021 to April 2023 underwent repeat testing for Lp(a) and measurement of OxPL:apoB, EPA and AA levels. OxPL:apoB was measured using chemiluminescent immunoassay. Fatty acid measurements were done via column chromatography/mass spectrometry. Lp(a), OxPL-apoB, EPA, and AA were log
e
-transformed to satisfy the assumption of normality.

Results:
We enrolled 238 patients with a mean age of 56.5 ± 13.5 years (46% being female, 69% white, 10% black, 14% Asian). Statin therapy was used in 66%, and mean LDL-C was 87.3 ± 47.5 mg/dL. Median (IQR) Lp(a), OxPL:apoB, AA, and AA:EPA ratio was 167.7 (57.3-233.5) nmol/L, 2.3 (1.2-3.9) nmol/L, 287.3 (234.8-350.2) ug/mL, and 10.3 (6.1-14.9), respectively. Lp(a) correlated with OxPL:apoB (r=0.48, p<0.0001). In multivariate analysis adjusting for age, race, sex, hypertension, LDL-C, statin use and PCSK9 inhibitor use, log-Lp(a) was associated with AA (p=0.002) and log-AA:EPA (p=0.02), but not associated with log-EPA (p=0.19). LogOxPL:apoB was associated with log AA (p=0.03).

Conclusion:
Higher Lp(a) levels are associated with elevated AA levels, suggesting a pathway by which Lp(a) may contribute to increased platelet aggregation and inflammation in patients with high Lp(a).
Abstract 17188: Electrocardiographic Algorithms for Localization Ventricular Ectopy From the Ventricular Outflow Tracts Demonstrate Poor Accuracy and Agreement
Authors: Howell Albert , Arps Kelly , Sun Albert , Wu Hau-Tieng , Loring Zak
Published: December 2023

Background:
Premature ventricular contractions (PVCs) and ventricular tachycardia (VT) commonly arise from the outflow tracts of the left and right ventricles and can be treated with catheter ablation when symptomatic or associated with cardiomyopathy. Accurate localization of these ectopic sources aids procedural planning. Several different electrocardiographic (ECG) algorithms have been published, but their relative performance has not been assessed.

Objective:
Compare the accuracy and agreement of three ECG algorithms for PVC localization.

Methods:
ECGs from patients who underwent catheter ablation for PVCs or VT originating the outflow tract region were analyzed using three published PVC localization algorithms. The predictions from these algorithms were then compared to the site of successful catheter ablation (right ventricular outflow tract [RVOT], left ventricular outflow tract [LVOT], or epicardium). The accuracy and agreement of the three algorithms were compared.

Results:
A total of 43 patients were evaluated and ectopy was suppressed via ablation from a single chamber in 37 (86%) of patients. VT/PVCs originated from the RVOT (N=10), LVOT (N=26), and epicardium (N=1). The three studied algorithms demonstrated accuracy rates of 46-70%. The algorithms disagreed on the predicted ectopy location for 19 (51%) patients. When all algorithms agreed (N=18), the prediction was accurate for only 11 patients (61%).

Conclusion:
Rules-based ECG algorithms demonstrate poor performance and use of different published algorithms frequently result in disparate results. More accurate and consistent methods incorporating individualized electroanatomic variation may improve accuracy and periprocedural management for PVC and VT ablation.
Abstract 17206: Targeted Ablation at Regions of High Oxidative Injury in Persistent Atrial Fibrillation in a Canine Model — A New Electrogram Based Therapeutic Strategy in Atrial Fibrillation?
Authors: Rottmann Markus , Pfenniger Anna , Yoo Shin , Johnson David , Zhang Wenwei , Wasserstrom Andrew , Knight Bradley P , Passman Rod S , Arora Rishi
Published: December 2023

Introduction:
Oxidative stress (OS) plays an important role in the development of atrial fibrillation (AF). However, it is currently not possible to detect regions of high OS in the atria of individual AF patients.

Hypothesis:
We hypothesized that in persistent AF, electrograms (EGMs) at sites of high OS, are uniquely sensitive to acute reactive oxygen species (ROS) scavenging with N-acetylcysteine (NAC), both in a large animal model and in patients and that ablation at these NAC-sensitive ‘hotspots’ can terminate or slow AF.

Methods:
We performed high-density mapping (both atria, pre/post-NAC, intravenous, 100mg/kg) in 17 persistent AF dogs (3-14 weeks rapid atrial pacing) using an epicardial mapping-plaque (6 regions, both atria, 130 electrodes, electrode-distance 2.5mm) (Figure 1) and in 5 patients (HD-grid, Abbott). We analyzed cycle length (CL) and dominant frequency (DF) in ‘hot spot’-sub-regions (>10% change pre vs. post-NAC). In 4 dogs we performed epicardial ablation (Atricure) at 3 quadrants of the mapping fields with the largest NAC hotspots of all 6 mapped regions (Figure 2).

Results:
NAC led to preferential organization of AF (>10% DF decrease) at several sites in both atria (NAC hot spots). In patients, NAC (Figure 3) increased CL in the left atrium in the left lateral wall and in the right atrium in the posterior lateral wall. The largest DF hotspots were in the left atrium in the superior wall. In dogs, ablation at the largest hotspots terminated AF in 50% of the cases (2/4). In all cases, ablation significantly increased CL in the left atrium and decreased DF in all atrial regions (Figure 2).

Conclusions:
Acute administration of NAC preferentially organizes AF electrograms in subregions of both atria (‘hotspots’). Ablation at these NAC-sensitive hotspot regions terminated or slowed AF. We have discovered a unique method to target identified atrial sub-regions of high OS in the atria. These ‘hotspots’ may be a new therapeutic target in patients with persistent AF.
Abstract 17209: Late Gadolinium Enhancement by Cardiovascular Magnetic Resonance versus Invasive Coronary Angiography: A Meta-Analysis on Diagnostic Accuracy for Cardiovascular Ischemia
Authors: Msherghi Ahmed , BenGhatnsh Ahmed , Khaled Ala , Elfaituri Ahmed , Faraj Hazem Abdelkarem , Elfaituri Muhammed K
Published: December 2023

Introduction:
Invasive Coronary Angiography (ICA) has been the gold standard for diagnosing cardiovascular ischemia, however, it carries an inherent risk due to its invasive nature. Late Gadolinium Enhancement (LGE) by Cardiovascular Magnetic Resonance (CMR) is a promising non-invasive alternative. This necessitates determining its diagnostic accuracy to inform clinical decision-making.

Hypothesis:
This study aims to assess the diagnostic accuracy of LGE by CMR and ICA in detecting cardiovascular ischemia.

Methods:
We performed a systematic review of studies until January 2023 across multiple databases, including PubMed, Embase, and the Cochrane Library, that compared the diagnostic accuracy of LGE by CMR and ICA for cardiovascular ischemia. Diagnostic performance measures, including sensitivity, specificity, false-positive rate estimates, diagnostic odds ratio, and positive and negative Likelihood Ratios (LR), were pooled using a random-effects model and presented with a 95% Confidence Interval (CI). R software (version 4.0.3) with the mada package was utilized for statistical analyses.

Results:
Our meta-analysis collected data from 8 studies encompassing 1,020 patients, of which 395 had confirmed ischemic imaging and 625 had confirmed non-ischemic heart imaging. The results revealed that LGE by CMR had high diagnostic accuracy for detecting cardiovascular ischemia. The sensitivity was 90.9% (95% CI: 80.2%-96.1%, I2=50.4%), the specificity was 89.3% (95% CI: 79.2%-94.8%, I2=90.5%), and the false-positive rate was 10.7% (95% CI: 5.2%-20.8%). The diagnostic odds ratio for LGE by CMR was 82.82 (95% CI: 25.2-272.5), and the positive and negative Likelihood Ratios were 8.46 (95% CI: 4.19-17.06) and 0.10 (95% CI: 0.05-0.23), respectively.

Conclusions:
This study demonstrates the high diagnostic accuracy of LGE by CMR for cardiovascular ischemia, as indicated by its high sensitivity, specificity, and substantial diagnostic odds ratio. These findings suggest that LGE by CMR could be a reliable non-invasive alternative to ICA, potentially improving clinical decision-making and reducing risks associated with invasive imaging. Further studies and policy reviews are needed to optimize the use of this promising diagnostic modality.