bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13880: Outcomes in Pregnant Women Hospitalized With Acute COVID-19 Infection
Authors: Mauricio Rina , Shah Sonia , Singh Kavisha , Sanghavi Monika , Morgan Jamie , Adhikari Emily , Ayers Colby , Michos Erin D , De Lemos James A , Das Sandeep R
Published: June 2023

Introduction:
There are conflicting data on COVID-19 outcomes in pregnant women. Using the AHA COVID-19 CVD Registry we evaluated COVID-19 outcomes in pregnant vs non-pregnant women with COVID-19.

Methods:
Women 18-40 years old hospitalized from March 2020 to December 2021 with symptomatic COVID-19 were included (n=2,068), with 110 (5.3%) pregnant at admission. Women with unknown pregnancy status were excluded. Vaccine data were limited (2.8% of participants), therefore omitted from analysis. Baseline demographics and symptoms at presentation were compared between pregnant and non-pregnant women (Table). Rates of death, mechanical ventilation, ICU admission, hospital stay ≥5 days, myocardial infarction, stroke, DVT, PE, and a composite of all outcomes were determined. Multivariable Cox regression analyses were performed, adjusting for comorbidities and prior CVD.

Results:
Pregnant women hospitalized with COVID-19 had fewer comorbidities than non-pregnant women (Table). There were no deaths in the pregnant group and 44 (2.3%) in the non-pregnant group. Fewer pregnant women were hospitalized ≥5 days (29.1% vs 41.2% non-pregnant); this difference was not statistically significant after multivariable adjustment [adjusted HR (95% CI), 0.67 (0.43-1.02)]. There were no significant differences between the groups in the composite outcome [adjusted HR (95% CI), 0.72 (0.48-1.07)] or its components (Table).

Conclusions:
Pregnant women hospitalized with symptomatic COVID-19 had fewer comorbidities compared with non-pregnant women. There were fewer deaths and lower rates of hospitalization ≥5 days in pregnant vs non-pregnant women which was no longer statistically significant after multivariable adjustment. The potential for residual confounding due to healthier pregnant women presenting with milder COVID-19 illness or being admitted for non-COVID-19 indications compared to non-pregnant women must be considered when interpreting these findings.
Abstract 13893: Higher Social Vulnerability Index is Associated With Higher Risk of Mortality Following Acute Myocardial Infarction in the USA
Authors: Chobufo Muchi Ditah , Rahman Ebad , Agbor Ndip , sattar yasar , Alharbi Anas , Gonuguntla Karthik , Mbome Yolande , balla sudarshan
Published: June 2023

Introduction:
Timely management of acute myocardial infarction (AMI) significantly improves outcomes. Patient and community-level characteristics are strong determinants of survival following AMI. The Social Vulnerability Index(SVI) is a robust community assessment tool that reliably ranks counties based on several parameters on a scale from 0 to 1. More vulnerable communities have higher SVI scores.

Hypothesis:
Higher levels of SVI scores will be associated with higher AMI-related deaths in the USA.

Methods:
Using the multiple causes of death database from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research(1999-2020), we extracted county-level deaths with any mention of AMI with ICD-10 codes I21 and I22. County-level SVI was obtained from CDC/ATSDR. We fitted segmented regression models to evaluate the association between quintiles of SVI scores and AMI-related age-adjusted mortality rate (AAMR, expressed per 100,000 persons). Analysis was done using STATA v17 and Joinpoint segmented regression softwares with p-values <0.05 considered statistically significant.

Results:
The AMI-related AAMR was 52.4 per 100,000 (95% CI 52.4 - 52.5) for the entire USA, decreasing from 87.4 (95% CI: 87.0 - 87.7) in 1999 to 38.2 (95% CI:38.0 - 38.4) in 2020. On average, each unit increase in SVI quintile was associated with a 12.5% higher AMI-related AAMR (beta=12.4%, 95% CI: 8.9 - 16.0, p=0.001), Figure 1.

Conclusions:
More vulnerable counties are associated with higher risk of AMI-related deaths. Further research is needed to identify and address the driving factors so as to reduce this disparity.
Abstract 13900: Combined Use of Venoarterial Extracorporeal Menbrane Oxygenation and Impella Improves the Outcome in Patients With Cardiogenic Shock
Authors: Nakayama Tomoko , Unoki Takashi , Kametani Motoko , Tsurusaki Yuta , Toyohuku Takaaki , Matsuura Junya , Hasegawa Satoko , Konami Yutaka , Suzuyama Hiroto , Kodama Kazuhisa , Yufu Tetsuo , Yamamuro Megumi , Taguchi Eiji , Sawamura Tadashi , NAKAO KOICHI , Sakamoto Tomohiro
Published: June 2023

Introduction:
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides benefit to patients in refractory cardiac arrest and cardiogenic shock. However, VA-ECMO elevates LV afterload and causes pulmonary edema and LV distension. Additional IABP support has been recommended in Japan to reduce LV afterload. Alternatively, transcatheter left ventricular assist device, Impella has been recently introduced. However, it remains to be evaluated if there is clinical benefit of concomitant use of VA-ECMO and Impella (ECPELLA).

Methods:
Aim of this single-site cohort study is to assess the effects of ECPELLA as compared with ECMO with IABP in patients who were managed with VA-ECMO due to refractory cardiogenic shock including cardiac arrest.

Results:
We retrospectively reviewed 253 consecutive patients, who received VA-ECMO from January 2012 to May 2022 in our institute. Among them, 67 patients who were managed with VA-ECMO alone were excluded. Patients were divided into two groups, ECEPLLA (n=68) and ECMO with IABP (n=118). We applied propensity score analysis with 1:1 score matching using dependent variables of age, the rate of sex, acute coronary syndrome, out-of-hospital and in-hospital cardiac arrest, and extracorporeal cardio-pulmonary resuscitation. We assessed 30-day survival rate, hemodynamic data, and safety profiles including acute kidney injury, blood transfusion and embolic cerebral infarction.

Results:
Following propensity score matching, 60 ECPELLA and 60 ECMO with IABP patients were included for analysis. The 30-day survival was significantly higher with ECPELLA group compared with ECMO with IABP group (ECPELLA: 48% vs. ECMO with IABP: 28%, p= 0.01, log-rank test). There were no statistical differences in ECMO weaning rate and safety profiles between treatment groups.

Conclusions:
ECPELLA may be associated with improved 30-day survival in patients with refractory cardiac shock including cardiac arrest.
Abstract 13910: Racial/Ethnic Outcomes Following Percutaneous Coronary Intervention
Authors: Wang Daniel R , Li Joshua , Parikh Rushi , Ziaeian Boback , Jackson Nicholas J , Hsu Jeffrey J
Published: June 2023

Introduction:
Asian-American/Pacific Islanders (AAPIs) and Hispanics are two of the most rapidly growing minorities, but both are poorly represented in the cardiovascular literature. In light of national quality improvement efforts to ensure adherence to cardiovascular therapy guidelines, this study examines guideline adherence and outcomes in AAPIs and Hispanics compared to non-Hispanic Whites (NHW) in a quaternary care center after percutaneous coronary intervention (PCI).

Methods:
1,896 AAPI, Hispanics, and NHW adults from February 28, 2012 to December 30, 2020 who underwent emergent or elective PCI were included. The primary endpoint was the prescription of post-PCI guideline-directed medical therapy including aspirin, statins, P2Y12 receptor blockers, and cardiopulmonary rehabilitation. Secondary endpoints included comorbidity burden, post-PCI morbidity and mortality, and prior PCI. Analyses were adjusted for age, sex, and insurance type.

Results:
Hispanics had the lowest median age and the highest rates of government insurance. Hispanics had lower odds of either ACE inhibitor or ARB prescription versus NHW (OR = 0.75, p = 0.03). Odds of ticagrelor prescriptions were lower for both Hispanics (OR = 0.56, p = 0.01) and AAPIs (OR = 0.62, p = 0.02) versus NHW. However, odds of clopidogrel prescriptions were higher for Hispanics than NHW (OR = 1.57, p = 0.01), while AAPIs trended towards the same (OR = 1.42, p = 0.05). No differences were found for statin or cardiopulmonary rehabilitation prescriptions. AAPIs and Hispanics had significantly higher risks of diabetes (OR = 2.28 and 1.8 respectively, p < 0.01) and of being on dialysis (OR = 2.25 and 2.52 respectively, p < 0.01) than NHW. AAPIs also had higher odds of hypertension than NHW (OR = 1.51, p = 0.01). Hispanics had significantly higher risk of post-PCI mortality versus NHW (OR = 2.12, p < 0.01).

Conclusions:
AAPIs and Hispanics had lower odds of ticagrelor prescription than NHW, and Hispanics had higher odds of clopidogrel prescription. Hispanics also had higher odds of mortality post-PCI. Further, AAPIs and Hispanics had higher comorbidity burdens. This study suggests that despite quality improvement efforts, work remains to be done to narrow health disparities.
Abstract 13913: Payer-Negotiated Prices for Transthoracic Echocardiography
Authors: Wei Chen , Milligan Michael , Assi Ali A , Lam Miranda , Sandhu Alexander T
Published: June 2023

Introduction:
Transthoracic echocardiography (TTE) is widely used in clinical practice. Medicare pays over $900 million annually for TTE. Using hospital-reported data, we sought to characterize variation in payer-negotiated (commercial) and self-pay prices for TTE within and across hospitals in the US.

Methods:
As of January 2021, federal price transparency legislation began requiring hospitals to publish chargemaster, discounted self-pay and commercial prices for all hospital services. We used the Turquoise Health database to gather this price data for TTE based on common procedural terminology (CPT) code 93306.

Results:
A total of 1,949 hospitals nationwide reported commercial prices for CPT 93306. Raw median prices varied widely across the US [$1398 (IQR $1064-$1661)] (Figure A). The median number of commercial plans per hospital was 20 (IQR 8-42) (Figure B). Compared with a median Medicare price of $464 (IQR $445-$493), the median commercial and discounted self-pay prices were $1313 (IQR $744-$1948) and $1422 (IQR $836-$2189) respectively, representing a 2.83- and 3.06-fold markup from the Medicare rate. The median chargemaster price was $2497 (IQR $1731-$3576), corresponding to a 5.38-fold markup. Within hospitals, the 90th percentile payer-negotiated rate was 2.78 (IQR 1.80-5.09) times the 10th percentile price (within-center ratio). Across hospitals within the same hospital referral region (HRR), the median price at the 90th percentile hospital was 2.47 (IQR 1.69-3.75) times that at the 10th percentile hospital (across-center ratio).

Conclusions:
Self-pay and commercial TTE prices are substantially higher than Medicare prices. There is significant variation in payer-negotiated rates within and across hospitals. More research is needed to understand the factors leading to this price variation and its relation to quality of care and access amidst rising healthcare costs in the US.
Abstract 13925: Initial Triglyceride Glucose Index as a Predictor of No-Reflow After Primary Percutaneous Coronary Intervention
Authors: Abdelnabi Mahmoud , Saleh Yehia , Benjanuwattra Juthipong , Del Rio-Pertuz Gaspar , Leelaviwat Natnicha , Almaghraby Abdallah
Published: June 2023

Introduction:
The triglyceride glucose (TyG) index is a screening method for insulin resistance that can be used on a daily clinical basis and only requires two laboratory determinations: serum triglycerides and serum glucose. Prospective studies of predictive values of the TyG index for cardiovascular diseases (CVD) have primarily focused on pre-existing coronary arterial disease or diabetes mortality, and the TyG index has been shown to be associated with subclinical atherosclerosis symptoms, such as arterial stiffness and preclinical coronary arterial calcification. The study aimed to investigate the possible correlation between the TyG index and the no-reflow phenomenon in patients presented with acute STEMI undergoing primary percutaneous coronary intervention (PPCI).

Methods:
A total number of 702 patients who presented with acute STEMI in the period from 1/9/2015 to 1/9/2019 who underwent PPCI according to the standard techniques were included. Patients with a previous history of diabetes, dyslipidemia, or on statin therapy were excluded from the study. Initial triglyceride levels as well as fasting blood glucose were tested in all patients at the time of admission. TyG index was calculated for all patients. No-reflow was defined as distal Thrombolysis in Myocardial Infarction (TIMI) flow less than III.

Results:
618 patients (88 %) had normal flow while 84 patients (12%) had no-reflow. The mean TyG index was 4.3±0.4 in the no-reflow group versus 4.2±0.4 in the normal reflow group (P = 0.03). After propensity matching, the mean TyG index was 4.2 ± 0.3 in both groups. (P = 0.99)

Conclusion:
In a retrospective observational study, there was no statistically significant difference between no-reflow and normal flow groups after propensity matching. Further research is required to detect whether the TyG index can be used as a readily available independent predictor of cardiovascular morbidity and mortality.
Abstract 13927: AAV Gene Therapy to Treat Underlying Cardiac Biomechanical Defects in
Lmna
Dilated Cardiomyopathy Improves Lifespan and Preserves Ejection Fraction in
Lmna
DCM Mouse Model
Authors: Werner Hendrikje , Gan Esther S , Loh Connie Y , Khaing Nyein Thet , Zhang Jinqiu , Ong Mervyn , Burke Brian , Tan Yann Chong , Stewart Colin L , Lee Yin Loon
Published: June 2023

Mutations in the
LMNA
gene are the second most common cause of genetic dilated cardiomyopathies (DCMs) with a prevalence of ~1/12500. Adeno-associated virus (AAV) gene therapies are a promising treatment modality for genetic disease. However, the autosomal dominant, gain-of-function mutations underlying
LMNA
DCM preclude standard gene replacement approaches. To understand
LMNA
DCM, we previously generated a mouse model that exhibits reduced ejection fraction, dilation of ventricular inner dimensions and increased cardiac fibrosis, surviving for only ~40 days after cardiac-specific deletion of the
Lmna
gene. We propose that the mutant
LMNA
gene weakens the structural integrity of the nucleus, making it vulnerable to biomechanical forces generated by contracting cardiomyocytes, which ultimately results in nuclear damage and a decline in cardiac function. Our gene therapy, AAV9-cTnT-GSLA01, prevents nuclear damage and disease in our
Lmna
DCM model by reducing biomechanical forces transmitted to the nucleus. To determine if we can treat, rather than prevent,
Lmna
DCM, we injected animals with AAV9-cTnT-GSLA01 at 1x10
14
vg/kg at different timepoints (21, 17, 14 and 1 day(s)) after induction of
Lmna
deletion. Treatment with AAV9-cTnT-GSLA01 17 days post
Lmna
deletion resulted in lifespan extension to 108 days (P= 0.0002), while earlier intervention at day 14 or day 1, improved lifespan to 122 and 208 days respectively (P = 0.0002, P= 0.0035). To address dose dependency of AAV9-cTnT-GSLA01, we delivered the vector at 5x10
13
vg/kg, 1x10
14
vg/kg, and 2x10
14
vg/kg at 17 days after
Lmna
deletion. Lifespan was extended from 40 days in untreated mice to 51.5 (P = 0.0135), 67.5 (P < 0.0001), and 103.5 days (P < 0.0001) respectively. The progressive decline of ejection fraction in these mice was attenuated in a dose-dependent manner. Thus, the positive effect of AAV9-cTnT-GSLA01 on lifespan and cardiac function in
Lmna
DCM mice is enhanced with increasing dose and transgene expression. Initial optimisation of the therapeutic expression cassette appears to improve lifespan extension significantly. AAV9-cTnT-GSLA01 is a novel gene therapy approach that promises to address the underlying cause of
LMNA
DCM.
Abstract 13938: Metabolically Healthy Obese and Incident Coronary Heart Disease in Adult Cancer Survivors
Authors: Kim Kyuwoong
Published: June 2023

Introduction:
There is a paucity of data on the combined association of metabolic health status and obesity with coronary heart disease (CHD) in adult cancer survivors who are at excess risk of CHD associated with potentially harmful side effects from some cancer therapies. Long-term cardiovascular health among adult cancer survivors who are metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUN), and metabolically unhealthy obese (MUO) as compared to those who are metabolically healthy non-obese (MHN) remains uncertain.

Hypothesis:
The hypothesis of this study was that adult cancer survivors who are MHO, MUN, MUO would have higher risk of CHD as compared to those who are MHN.

Methods:
Data on metabolic health status and incident CHD among adult cancer survivors (n=2,336) were abstracted from the National Health Insurance Service-Health Screening Cohort, 2002-2019 along with information on confounding variables (sociodemographic factors, health status, health behavior, and family history of heart disease). Obesity was defined as body mass index≥25.0 kg/m
2
and the participants were considered metabolically unhealthy if they met more than three out of the five (fasting serum glucose, blood pressure, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol) criteria for worsened metabolic health. Cox proportional hazards model adjusted for the confounding variables was used to compute hazard ratios (HR) and 95% confidence intervals (95% CI) for incident CHD according to the metabolic health and obesity categories.

Results:
Among adult cancer survivors, those who are MHO (HR=2.80; 95% CI: 1.65-4.76), MUN (HR=2.58; 95%: 1.12-5.97), and MUO (HR=4.88; 95% CI: 2.27-10.5) had higher risk of incident CHD as compared to those who are MHN.

Conclusions:
Adult cancer survivors who are MHO should also be of a clinical concern. Excess body weight and metabolic health status should be concurrently managed to reduce the risk of developing CHD among adult cancer survivors.
Abstract 13947: Heparin-Mediated Release of Hepatocyte Growth Factor at the Acute Phase of STEMI
Authors: Leboube Simon , Hayek Ahmad , Paccalet Alexandre , PILLOT Bruno , Brun Camille , Abousaleh Iyad , PRIEUR Cyril , Scheppler Bertrand , Thibault Helene , Rioufol Gilles , Mewton Nathan O , Bidaux Gabriel , Crola Da Silva Claire , Bochaton Thomas
Published: June 2023

Introduction:
Hepatocyte Growth Factor (HGF) is a cytokine promoting cell survival via its receptor c-met. Heparin injection is known to induce a massive release of native HGF in blood. Heparin is used at the acute phase of myocardial infarction (MI). However, HGF release at the acute phase of MI and its potential cardioprotective effect is unknown.

Hypothesis:
We aimed to assess HGF kinetics in a cohort of ST-elevation myocardial infarction (STEMI) and its potential cardioprotective effect.

Methods:
We prospectively included consecutive STEMI patients admitted in our hospital from 2016 to 2019. All patients underwent coronary angiography with revascularization. Sera were collected at 5 time points (admission, 4 hours (H4), H24, H48 and 1 month after STEMI). Samples were stored at -80°C. HGF levels were assess by ELISA. We used a mouse model of myocardial ischemia reperfusion (ligation of the left anterior descending coronary artery followed by reperfusion) to evaluate HGF effect.

Results:
We included 230 patients. We observed an intense and early peak of HGF as early as admission, before revascularization (8750 pg/ml, IQR [8021-9492]) followed by a rapid decrease within the first 48h (p<0.0001). We demonstrated that this rapid increase was induced by heparin administration (unfractionated heparin or low molecular weight heparins). To evaluate the effect of HGF on myocardial infarct size we administrated HGF or placebo in mice during myocardial reperfusion. In the HGF group, infarct size was significantly smaller compared to the control group (52.0% of left ventricle vs 58.0%, p=0.002).

Conclusions:
We demonstrated an intense and early HGF peak at the acute phase of STEMI, induced by heparin. In our preclinical mouse model, HGF had cardioprotective effect after MI. Thus we may suppose that heparin-mediated release of HGF at the acute phase of STEMI have cardioprotective effect that may confer a basal cardioprotection in all patients.
Abstract 13952: Incidence of In-Hospital Cardiac Arrest and Associated In-Hospital Mortality in Pediatric Critically Ill Patients With Cardiac Disease Significantly Decreased Over Time: Results From a Systematic Review and Meta-Analysis
Authors: Sperotto Francesca , Daverio Marco , Gregor Dario , Dorste Anna , Allan Catherine K , amigoni angela , Thiagarajan Ravi R
Published: June 2023

Introduction:
Studies evaluating trends in the incidence and mortality for in-hospital cardiac arrest (IHCA) in children with cardiac disease admitted to the intensive care unit (ICU) are rare. Additionally, there is limited information on factors associated with IHCA and mortality.

Hypothesis:
We hypothesized that the incidence of IHCA and the mortality rate in cardiac children admitted to the ICU has significantly decreased over time.

Methods:
We conducted a systematic review of PubMed, Web of Science, EMBASE, and CINAHL from inception to Sept 2021. Random effects meta-analysis was used to compute pooled-proportions and pooled-ORs. Meta-regression adjusted for type of study (registry vs cohort) and diagnostic category (surgical vs general cardiac) was used to evaluate trends in incidence and mortality.

Results:
Of the 2,574 studies identified, 25 were included in the systematic review (126,087 patients), 18 in the meta-analysis. Five percent (95% CI: 4-7%) of ICU children experienced IHCA and 35% (95% CI: 27-44%) did not achieve ROSC. In centers with ECMO, 21% (95% CI: 15-28%) underwent ECPR. The pooled in-hospital mortality was 54% (95% CI: 47-62%). Both incidence of IHCA and in-hospital mortality decreased significantly in the last 20 y (p<0.001, Figure 1, and p=0.020, respectively), while the proportion of patients achieving ROSC did not change (p=0.572). Neonatal age, prematurity, comorbidities, univentricular physiology, arrhythmias, pre-arrest mechanical ventilation, ECMO, and higher surgical complexity increased IHCA and mortality odds.

Conclusions:
A significant proportion (5%) of cardiac children in the ICU experience IHCA. Decreasing trends in IHCA and in-hospital mortality suggests that education on preventive measures and post-arrest care have been effective. However, unchanged proportion of patients not achieving ROSC illustrates the crucial need for developing resuscitation strategies specific to children with cardiac disease.
Abstract 13992: Antiplatelet Therapy Reduces Mortality When Compared to Direct Oral Anticoagulants in Post-Transcatheter Aortic Valve Replacement Patients Without Any Indication for Anticoagulation
Authors: Barbosa Moreira Matheus Jose , Araujo do Amaral Peixoto Natália , Udoma Udofa Ofonime Chantal , de Lucena Silva Araujo Silvia , Tinajero Shirley
Published: June 2023

Introduction:
Transcatheter Aortic Valve Replacement (TAVR) is a widely used minimally invasive treatment for severe aortic stenosis. Though the procedure is safe and effective, patients are still at risk for ischemic and hemorrhagic events after this intervention. The post-procedure antithrombotic management in these patients continues to be a source of debate, particularly in patients who do not have a preexisting or concurrent comorbidity which requires long-term anticoagulation therapy.

Methods:
We performed a systematic review and meta-analysis to compare Direct Oral Anticoagulants (DOACs) versus antiplatelet therapy after TAVR in patients without previous indication for chronic oral anticoagulation. PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials (RCTs). Risk ratio (RR) with P value < 0.05 were considered statistically significant. The primary endpoints of interest were death, obstructive valve thrombosis and major bleeding. No time for follow-up was limited.

Results:
Three studies involving 2922 patients undergoing TAVR were included. Of the participants, 1459 received antiplatelets and 1463 received DOACs. Antiplatelets were associated with significantly lower all-cause mortality (RR 1.68 [1.22-2.30], 95%IC; p=0.001). Major bleeding did not differ significantly between groups, but DOACs had a higher risk of bleeding when compared to antiplatelet drugs (RR 1.44 [0.90-2.32]; 95%IC, p=0.13). The antiplatelet group had a significantly higher risk of valve thrombosis than the DOACs group (RR 0.27 [0.14-0.51]; 95%IC; p<0.0001).

Conclusions:
This meta-analysis suggests that the use of antiplatelet, in comparison to the DOACs, after the TAVR procedure, reduces all-cause mortality, without significantly increasing the risk of bleeding. However, DOACs have been shown to reduce valve thrombosis. This is the best current evidence available. More RCTs, however, are needed to consolidate these findings.
Abstract 13998: Glycemic Control and Prognosis in Patients With Type 2 Diabetes Mellitus Hospitalized for Decompensated Heart Failure With Preserve Ejection Fraction
Authors: Onishi Toshinari , Iwakura Katsuomi , Okada Masato , Tanaka Nobuaki , Heitaro Watanabe , OKAMURA ATSUNORI , Seo Masahiro , Yano Masamichi , Hayashi Takaharu , Nakagawa Akito , Nakagawa Yusuke , Tamaki Shunsuke , Yamada Takahisa , Yasumura Yoshio , Sotomi Yohei , Hikoso Shungo , Nakatani Daisaku D , Sakata Yasushi
Published: June 2023

Background:
In patients with type 2 diabetes mellitus (T2DM), poor glycemic control is associated with higher risk of heart failure (HF) and cardiovascular death. On the other hand, the U-shaped relationship between HbA1c and mortality in T2DM patients with HF was reported by previous studies. The relationship between glycemic control and prognosis in patients with HF with preserved ejection fraction (HFpEF) is not fully elucidated.

Methods:
We enrolled 345 T2DM patients (80±25 years, Male 48.4%) registered in the PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction), a multicenter registration of patients hospitalized for decompensated HFpEF, between June 2016 and December 2020 for the present study. We performed echocardiography and measured HbA1c before discharge, and followed patients for median of 388 days (IQR 257-729 days) to observe the major adverse cardiovascular events (MACE; composite of death, HF hospitalization and stroke). We divided patients based on HbA1c into 5 groups (<6.5%, 6.5-6.9%, 7.0-7.5%, 7.5-8.0% and >8.0%).

Results:
There was no significant difference in age, gender, echocardiographic parameters among the groups. Cox proportional hazard model revealed that age (p=0.01) and HbA1c<6.5% (p=0.01) were independent predictors for MACE, and hazard ratio (HR) for MACE in patients with HbA1c<6.5% was 1.75 (95% CI, 1.10 to 2.77) comparing to those with HbA1c 6.5-6.9%. Patients with HbA1c>8.0% tended to have higher incidence of MACE (p=0.076, HR 1.73 95%CI, 0.94 to 3.17).

Conclusions:
Among T2DM patients with hospitalized for HFpEF, HbA1c<6.5 was associated with higher incidence of MACE, and there might be U-shaped relationship between HbA1c and MACE incidence.
Abstract 14021: A Meta Analysis for Clinical Outcomes of Transcatheter Aortic Valve Replacement in Patients With Bicuspid versus Tricuspid Aortic Valves Using Balloon Expandable versus Self Expanding Valves
Authors: Wang Enhua , Radwan Yasser , Salam Mohammad F , Saeed Al-Asad Khalid , Halboni Adnan , Al-abcha Abdullah , Saleh Yehia , George Abela
Published: June 2023

Introduction:
Over the past decade, several next generation transcatheter aortic valve replacement (TAVR) devices have been developed with the aim of improving patients’ outcomes. Bicuspid aortic valves (BAVs) are an emerging issue in TAVR practice. The goal of this study was to compare clinical outcomes of TAVR using balloon-expandable (BE) versus self-expanding (SE) transcatheter heart valves in patients with BAV vs tricuspid aortic valve (TAV).

Methods:
We searched PubMed, Cochrane and Embase databases systematically for relevant studies from inception to March 2022. The primary focus was 1-year all-cause mortality. Additional outcomes included short term (30-days) all-cause mortality, cardiovascular mortality, stroke, major/life threatening bleeding, permanent pacemaker (PPM) implantation and major vascular complications.

Results:
There were 28 studies with a total 346,033 patients who underwent TAVR, 17,835 of which had BAV stenosis. In the BE group, there was a statistically lower risk of mortality of TAVR in the BAV when compared to the TAV (OR 0.69 [95% CI 0.49-0.97]; p=0.03). In terms of short-term outcomes of BE group, the risks of all-cause mortality, stroke, PPM implantation, major bleeding, and major vascular complications were all similar between the two arms. In the SE group, there were not statistically significant in the clinical outcomes between patients in BAV and TAV.

Conclusions:
The use of balloon-expandable valves in TAVR was associated with a lower risk of 1-year mortality in patients with BAV compared to patients with TAV. These data support the need for a randomized trial to compare the balloon-expandable valves in BAV patients.
Abstract 14028: Predictors of Atrial Fibrillation Free Survival in Patients With Implantable Cardiac Devices
Authors: Mai Phu , Kim Michael H , Roka Attila
Published: June 2023

Introduction:
Improvement of atrial fibrillation (AF) burden can be occasionally observed after pacemaker (PM) implant in patients with tachy-brady syndrome. On the other hand, patients may develop AF after the implant, even without prior history. We studied whether pre-implant parameters affect the risk of death or AF after device implant.

Methods
Data from 200 consecutive patients who underwent Medtronic dual (DDD) or triple chamber/cardiac resynchronization therapy (CRT) PM or ICD implants were analyzed. Pre-implant data included demographics, vitals, medications, comorbidities, labs, EKG, characteristics of any prior AF, echocardiographic parameters, and planned device type. Follow-up duration was planned as 12 months; survival and AF data (episodes >5 minutes) were collected from device follow-up data. Survival analysis was performed for death and first AF occurrence.

Results
Average age was 75±10 years, 37% were female. Comorbidities included history of AF (26% paroxysmal, 13.5% persistent), coronary artery disease 48.5%, hypertension 83.5%, diabetes 37.5%, sleep apnea 26%, drug or alcohol abuse 12.5%, heart failure 43%, prior cerebrovascular event 9.5%. PM was implanted in 70%, ICD in 30% of patients; DDD devices in 83.5%, CRT in 16.5%.Follow-up duration was 338±111 days, mortality was 13%, 38.5% of patients had new onset or recurrent AF. There was no difference in mortality between the PM vs. ICD group (11.4% vs. 16.7%, p=0.597) and the DDD vs. CRT group (12.6% vs. 15.2%, p=0.781). The cumulative AF incidence was higher in the PM vs. ICD group (46.7% vs. 21.7%, p=0.037) and in the DDD vs. CRT group (41.9% vs. 21.2%, p=0.039).

Conclusion:
The type of implanted device, guided by pre-implant clinical parameters affects post-implant AF occurrence. Although ICDs and CRT are utilized in sicker patients, these groups had better AF outcomes - beneficial effects of cardiac resynchronization and routine use of goal-directed medical therapy in these patients prior to and after the implant may play a role.
Abstract 14044: Leveraging Multi-Omics to Identify Biologically-Informed Clusters of Individuals With Differing Underlying Disease Risk Mechanisms Using an Innovative Network Modelling Approach
Authors: Bagheri Naraghi Minoo , De Meulder Bertrand , Annis Jeffrey , Brittain Evan , Mosley Jonathan , Ferguson Jane F
Published: June 2023

Background:
The rates of known cardiometabolic risk elevation are highly variable among patients suggesting that there are other risk mediators underlying diseases. We hypothesized that using cutting-edge and innovative multi-omics integrative network analysis in conjunction with the consensus clustering approach would identify clusters of individuals which may represent novel functional and/or pathophysiological risk mechanisms of cardiometabolic disorders.

Methods:
The genetically predicted levels of metabolites and proteins constructed from the GWAS data of Framingham/Malmö and KORA-TWINS were imputed in 13,562 BioVU participants. These 2 layers of omics data were integrated using similarity network fusion in conjunction with consensus clustering approaches. The identified clusters of individuals were tested for associations with 14 cardiometabolic diseases using logistic regression adjusting for known risk factors to identify endotypic determinants of diseases. Pathway analysis comparing each cluster to the rest of participants was performed using Reactome and MetaboAnalyst.

Results:
We identified 5 clusters across which LDL-C was significantly (p=0.001) different. The significant associations were found for cluster 1 with coronary artery disease (p=0.04), cluster 2 with cardiomyopathy(p=0.004) and atrial fibrillation (p=0.03) and cluster 4 with congenital heart disease (p=0.03) [
Fig 1
]. Thus, clusters 1, 2 and 4 are endotypic determinants of the above diseases. Each of these clusters was associated with distinct pathways indicating candidate mechanisms of diseases related to the clusters.

Conclusions:
This novel discovery-oriented multi-omics clustering method identified biologically-related subgroups of individuals and revealed novel risk mechanism and biomarkers of cardiometabolic diseases. The innovative network-based models advance precision medicine by enabling future prognostic risk prediction tools.
Abstract 14054: Monocyte Vascular Endothelial Growth Factor Receptor-1 Signaling in Peripheral Artery Disease
Authors: Zaied Abdelrahman A , Brewer Lauren , Rezaee Sholeh , Threlkeld Edie , Leanhart Silvia , Hamilton Adeleigh , Annex Brian H
Published: June 2023

Introduction:
Peripheral artery disease (PAD) is caused by atherosclerosis of large arteries of the leg(s). Beyond complications from poor perfusion to the legs, patients with PAD suffer higher than expected rates of heart attack and strokes. Monocytes are subdivided into three subtypes: CD14++CD16- (classical), CD14+CD16+ (intermediate), and CD14-CD16+ (non-classical). The intermediate monocyte subtype is linked to PAD. Vascular Endothelial Growth Factor receptor (VEGFR)-1 is a member of tyrosine kinase family that is expressed in monocytes and has high affinity for the VEGF-A ligand. Recent studies showed that inhibition of VEGFR1/STAT-3 signaling decreases angiogenesis in PAD. We hypothesized that in patients with PAD, intermediate monocytes would have less VEGFR1/STAT3 activation than controls.

Methods:
Blood samples were collected from PAD patients (n=11) and risk factor closely matched controls (n=17). PBMCs were isolated by gradient centrifugation. By flow cytometry, gating strategy on monocytes was done by excluding granulocytes (CD66b), B and T lymphocytes (CD3,CD19), and natural killer cells (CD56). Next, monocytes were subdivided into three populations (intermediate, classical, and non-classical) by gating according to their CD14/CD16 expression. Within each population, levels of p(Y1333)VEGFR1, VEGFR1, pSTAT3, and STAT3 were determined.

Results:
Data from flow cytometry analysis showed a significant increase in the intermediate monocyte population in PAD vs control (~1.5-fold change; p=0.01). However, there was no significant difference in the non-classical or classical monocytes between PAD and control. Within the intermediate monocytes, P(Y1333) VEGFR1/VEGFR1 was decreased (~2-fold change) and pSTAT3/STAT3 was significantly decreased (~2-fold change) in PAD vs control. In both the non-classical and classical monocytes, there was no significant difference in either phosphorylated receptor between PAD and control.

Conclusions:
The data confirm the intermediate monocyte is associated with PAD and suggest that VEGFR1/STAT3 signaling is decreased in intermediate monocytes in PAD vs control. Understanding the mechanism of VEGFR1 activation may prove to be a promising therapeutic target for patients with PAD.
Abstract 14059: Correlation Between Demographics, Clinical Characteristics, Hemolytic Markers, and Pulmonary Hypertension Confirmed by Invasive Hemodynamics in Sickle Cell Disease
Authors: Brett Rachel , Saraf Santosh , Darbar Dawood , Tofovic David
Published: June 2023

Introduction:
Pulmonary hypertension (PH) is a common complication and cause of death in sickle cell disease (SCD). Prior study demonstrated poor correlation between the assessment of mean pulmonary artery pressures (mPAP) by echocardiogram (TTE) and right heart catheterization (RHC) in SCD. Yet, most PH studies in SCD have used TTE for the identification of PH. We sought to better characterize the clinical features of symptomatic SCD patients with/without PH confirmed on invasive testing.

Methods:
All symptomatic, defined as dyspnea or shortness of breath, SCD patients with RHC between 2008-2017 in a single large center in the Chicagoland area were recruited. PH was defined by mPAP
>
20 mmHg. Based on World Health Organization PH classification, Group 2 PH was differentiated from Group 1 PH by a pulmonary capillary wedge pressure (PCWP) ≥16 mmHg. Diagnosis and etiology of Group 1 PH was confirmed by chart review. We analyzed categorical and continuous variables using Pearson’s χ2 test and the Student’s t test, respectively, with Bonferroni correction as appropriate.

Results:
62 individuals with SCD and invasive hemodynamic testing were identified. All were African American, 37% were female, 90.3% were homozygous SS genotype, and 74.2% were on hydroxyurea (
Table 1
). Only mean LDH concentration was significantly different in those with PH compared to without (361 vs 448 U/L;
P
=0.02). Compared to Group 1 PH, those with Group 2 PH were younger (34.5 yr vs. 49 yr.;
P
=0.01), had higher mPAP (38 mmHg vs. 28 mmHg;
P
=0.002), had a higher prevalence of hypertension (
P
=0.03) and chronic kidney disease (
P
=0.004), and were frequently on a diuretic, angiotensin pathway blocking medication, calcium channel blocker, β-blockers, and/or nitrates (
Table 1)
.

Conclusions:
In symptomatic patients with SCD, PH diagnosed on invasive hemodynamics is associated with higher LDH. Those with Group 2 PH tend to be younger, have worse renovascular disease, and require more cardiovascular medications.
Abstract 14064: Utility of Tricuspid Annular Plane Systolic Excursion Normalized by Right Ventricular Size in Pulmonary Hypertension to Predict Exercise Capacity, Pulmonary Compliance, and Clinical Outcomes
Authors: Heffernan Shannon E , Tao Ran , Dharmavaram Naga , Ma James , Baber Aurangzeb , Dhingra Ravi , Masri Sofia C , Rahko Peter S , Farhan Raza
Published: June 2023

1. Introduction:
While tricuspid annular plane systolic excursion (TAPSE) captures the predominant longitudinal motion of right ventricle (RV), it may not accurately predict ventricular function as the RV dilates. Hence, normalizing TAPSE to ventricular area (in systole: TAPSE/RV-area-S, and diastole: TAPSE/RV-area-D) may lead to improved assessment of right heart function. In this study, we aim to determine the utility of RV size-indexed-TAPSE metrics in predicting exercise capacity and clinical outcomes.

2. Methods:
We perform a retrospective analysis of 71 consecutive subjects undergoing invasive exercise hemodynamics with cardiopulmonary exercise test for evaluation of dyspnea. Patients were classified into four groups: pulmonary arterial hypertension, isolated post-capillary, combined pre-/post-capillary PH, and control (no PH) based on hemodynamic analysis. Transthoracic echocardiogram data included: TAPSE (mm), TAPSE-index-D (RV end-diastole area in cm), and TAPSE-index-S (RV end-systole area in cm). Subjects were followed for 12 months after hemodynamic study for adverse events (death, heart failure hospitalization).

3. Results:
On ROC analysis of indexed-TAPSE to predict pulmonary compliance (>3.0 ml/mmHg), we identified optimal cutoff of 1.1 for TAPSE-index-D (AUC=0.792, p<0.001), 1.5 for TAPSE-index-S (AUC=0.827, p<0.001), and 17 mm for TAPSE (AUC=0.672, p=0.005). Similar results were obtained for predicting %predicted VO
2
max (>50%). We dichotomized indexed-TAPSE based on ROC analysis. As shown in the Figure, compared to the current recommended TAPSE cut-off of 17 mm, RV size-indexed TAPSE metrics were both superior in predicting adverse outcome (p<0.01).

4. Discussion/Conclusion:
Normalizing TAPSE to RV size can capture longitudinal and radial motion of the RV as the ventricle dilates and have better ability to predict clinical outcomes (death and HF hospitalization).
Abstract 14072: Heart Retransplantation Under the 2018 Adult Heart Allocation Policy
Authors: Kim Samuel T , Helmers Mark , Iyengar Amit , Herbst D. Alan , Weingarten Noah , Atluri Pavan
Published: June 2023

Introduction:
The new adult heart allocation policy was implemented on October 18, 2018. The purpose of the present study was to characterize the impact of this policy change on waitlist and post-transplant outcomes of heart retransplantation in the United States.

Methods:
All adults listed for heart retransplantation from May 2015 to March 2022 were identified using the United Network for Organ Sharing database. Patients were stratified into equal time eras (pre- and post-policy) based on the heart allocation change on October 18, 2018. Competing risks regressions were used to determine differences in waitlist outcomes, including waitlist death or deterioration and retransplantation rates following listing. Kaplan-Meier survival estimates were used to assess differences in 1-year post-transplant survival between eras.

Results:
Overall, 672 heart transplant candidates were included in analysis, with 49% listed during post-policy. Retransplantation candidates listed during post-policy were of similar age (45 vs 47 years, P=0.11) and female gender (33% vs 34%, P =0.70) compared to pre-policy candidates. Post-policy candidates had a shorter median waitlist duration (51 days vs 80 days, P<0.01), along with a lower likelihood of death or deterioration on the waitlist (subdistribution hazard ratio, SHR 0.45, 95% CI 0.27-0.74) and higher likelihood of retransplantation within 30 days of listing (SHR 2.65, 95% CI 1.86-3.80) compared to pre-policy (Figure). Among those retransplanted, pre-policy recipients experienced similar rates of 30-day post-transplant mortality (6.9% vs 6.7%, P=1.00) and 1-year post-transplant survival (82% vs 87%, P=0.24).

Conclusions:
Heart retransplantation candidates have experienced improved waitlist outcomes following the 2018 adult heart allocation policy without significant changes to post-transplant survival. Continued monitoring for long-term outcomes is warranted in this patient population.
Abstract 14074: Unique Circulating microRNA Profile in Pediatric Heart Transplant Recipients
Authors: Miyamoto Shelley D , Pietra Ashley , Feingold Brian D , Neltner Bonnie , Wilkinson James D , Karimpour-Fard Anis , Webber Steven A , Sucharov Carmen C
Published: June 2023

Introduction:
MicroRNAs (miRs) are small noncoding RNAs capable of modulating the expression of many genes.

Hypothesis:
Our hypothesis was that circulating miRs would be a biomarker of acute cellular rejection (ACR) in pediatric heart transplant recipients (PHTR).

Methods:
An array for 381 miRs was performed using serum from 52 PHTR and 21 healthy pediatric controls (HC). ACR was defined as ISHLT biopsy score ≥2R. Patients with antibody mediated rejection were excluded. RNA was extracted using the miRNeasy Mini Kit (Qiagen), and arrays were performed using the TaqMan Open Array miR panel (Thermo Fisher Scientific). Statistical analysis included Random Forest (RF) with area under the receiver operator curve (AUC) based on the top 3 differentiating miRs by RF, and Wilcoxon rank-sum t-test (significant q-value < 0.05).

Results:
Of the 52 PHTR, median age 8.5 years, 44% female, race/ethnicity white in 83%, 12% African American, 13% Asian/other, and 13% Hispanic; 22 PHTR had ACR at time of serum collection. There were 21 HC, median age 5.6 years, 38% female, race/ethnicity white in 76%, 24% Asian/other, and 19% Hispanic. There were 66 miRs significantly different between HC and all PHTR (AUC of 0.91). For HC vs PHTR without ACR there were 50 differential miRs (AUC of 0.94), and for HC vs PHTR with ACR there were 51 differential miRs (AUC 0.96). Table 1 demonstrates miRs that are differentially expressed compared to HC based on the presence or absence of ACR. Circulating miRs were not different between PHTR with (n=22) and without ACR (n=30).

Conclusions:
The circulating miR profile of PHTR is unique compared to HC, suggesting a strong influence of the transplant mileu on miR expression. There were 17 miRs with differential expression compared to HC based on the presence or absence of ACR. These results support future investigations in larger populations to determine if circulating miRs could serve as biomarkers of ACR in PHTR, and whether these miRs contribute to the pathophysiology of ACR.
Abstract 14112: "
Leave My Tongue Alone
:" Is the Myth of Tongue Swallowing Still Preventing Proper Cardiopulmonary Resuscitation Efforts of Athletes With Cardiac Arrest?
Authors: Viskin Dana
Published: June 2023

Introduction:
In 2017, we reported that during cardiac arrest (CA) events of athletes caught on video, the initial response of fellow teammates and paramedical personnel, is incorrect and disturbing: An attempt to prevent and/or relief "tongue swallowing" takes precedent over chest compression. We aimed to see if our report had any impact on the proper resuscitation of athletes.

Methods:
We continued our internet search for events of CA or transient loss of consciousness (LOC) severe enough to prompt resuscitation. For each video, we focused on the resuscitation maneuvers performed by fellow athletes. In addition, we reviewed the news coverage of each event, to learn how the resuscitation efforts are described in social media.

Results:
We expanded our original 29-video-collection to a total of 42 videos and 1 news article, showing athletes collapsing with CA (n=33) or LOC prompting resuscitation (n=10). The athletes with witnessed CA had a mean age of 25
+
4 years and all but one were male. The first intervention was visible in 37 videos and in 83% it was an obvious attempt to prevent "tongue swallowing.” Chest compressions were applied to only 33% of athletes. Media coverage, in 34 lay press articles, portrayed this wrong response as “heroic” in 6 cases. In the rest, the wrong resuscitation maneuvers were neither criticized nor questioned. The phrase “preventing tongue swallowing” appears in 3 articles, all highly publicized (BBC, ESPN etc). When an athlete did not survive following these wrong cardiopulmonary resuscitation manoeuvres, the lay media ignored the erroneous resuscitation.

Conclusion
The lay-media coverage of CA events of athletes portrays a disturbing reality in which wrong actions by first responders, including the prevention of tongue swallowing, are deemed heroic, while the necessary criticism of these actions is absent.