bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12287: Adipokines and Transitions in Metabolic Risk Over Time: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Ozkan Bige , Zhang Sui , Echouffo Tcheugui Justin B , Florido Roberta , NAMBI VIJAY , Michos Erin D , Abushamat Layla , Matsushita Kuni , Gerstenblith Gary , Blumenthal Roger , Hoogeveen Ron C , Ballantyne Christie M , Coresh Josef , Selvin Elizabeth , Ndumele Chiadi E
Published: June 2023

Introduction:
Individuals with similar weights have substantial heterogeneity in metabolic risk, a key indicator of cardiovascular disease risk. Additionally, many persons progress from metabolically healthy to metabolically unhealthy status, or regress in metabolic risk, over time. The association of adipokines with transitions in metabolic risk status is unknown.

Methods:
Among ARIC Visit 2 (1990-92) participants without diabetes, we evaluated the associations of adipokines (adiponectin and leptin; in tertiles) with metabolic risk transitions from Visit 2 to Visit 4 (1996-98; a 6-year interval) among persons with and without obesity using logistic regression. We examined transitions from metabolically healthy (no metabolic syndrome [MetS]) to unhealthy status (MetS, with or without diabetes). Among those with MetS without diabetes at Visit 2, we examined adipokine associations with progression to MetS with diabetes and with regression to metabolically healthy status.

Results:
Among 7,560 participants, mean age was 57 with 56% female and 17% Black adults. Higher adiponectin levels were associated with about 75% lower risk of progression from metabolically healthy to unhealthy status in those with and without obesity, whereas higher leptin was associated with about 3-fold greater risk of progression (Table, Panel A). Among those with MetS at Visit 2, higher adiponectin was associated with lesser risk of progression to diabetes, and greater likelihood of regression to metabolically healthy status in those with and without obesity (Table, Panel B). Conversely, higher leptin was associated with greater risk of progression to diabetes in those with obesity.

Conclusion:
Adipokine levels are linked to transitions in metabolic risk status over time among persons with similar weight status. Adipokines may identify individuals at greatest risk of developing metabolic risk factors, who may benefit most from aggressive CVD prevention strategies.
Abstract 12307: Exercise-Induced Ventricular Fibrillation in Patients with Brugada Syndrome Phenotype
Authors: Ueoka Akira , Morita Hiroshi , Mizuno Tomofumi , Masuda Takuro , Asada Saori , Miyamoto Masakazu , kawada satoshi , nakagawa koji , Nishii Nobuhiro , Nakamura Kazufumi , Ito Hiroshi
Published: June 2023

Introduction:
Ventricular fibrillation (VF) in Brugada syndrome (BS) patients are thought to be triggered by vagal nerve activation, which leads to sudden cardiac arrest (SCA) at rest or while asleep. Generally, exercise is not considered as trigger of SCA in BS patients.

Aim:
To report 2 rare cases of patients with BS phenotype developing exercise-induced ventricular (VF).

Case reports:
Case 1: 48 year-old male developed SCA during marathon running and was successfully resuscitated with cardiopulmonary resuscitation (CPR). The stored automatic external defibrillator (AED) electrogram (ECG) showed VF. The 12-lead ECG did not show abnormal morphology, however sodium channel blocker challenge test (intravenous injection of pilsicainide, a pure sodium channel blocker 1mg/Kg) unmasked typical type-1 BS ECG. The treadmill stress test induced single premature ventricular contraction by Bruce protocol, and ventricular tachycardia by a flat-out dash without a run-up. Genetic analysis did not show mutation of
SCN5A
gene. Case 2: 18 year-old male experienced SCA while playing basketball and was successfully resuscitated with CPR. The stored ECG record of AED showed VF. The 12-lead ECG showed normal result, then we performed the drug challenge test. Pilsicainide unmasked typical type-1 BS ECG. He also had exercise-induced atrial fibrillation (AF) and experienced inappropriate shock delivery from implantable cardioverter defibrillator. The treadmill stress test by Bruce protocol did not induce any ventricular arrhythmias. We avoided a flat-out dash protocol because of possibility of exercise-induced AF. Genetic analysis did not show
SCN5A
mutation.

Conclusion:
These 2 rare cases of drug-induced BS phenotype developing exercise-induced VF highlight important role of exercise testing as risk stratification tool in certain BS patients.
Abstract 12334: A Systematic Review and Meta-analysis Curriculum for Internal Medicine Residents Interested in Cardiology
Authors: Asad Zain Ul Abideen , Reese Jessica , Clifton Shari , Chakrabarty Shouvik , Bronze Michael , Sivaram Chittur A
Published: June 2023

Introduction:
Internal Medicine (IM) residents face major challenges in conducting original research due to inadequate instruction in research methodology and lack of mentorship during the traditional research electives offered during residency.

Hypothesis:
A novel systematic review curriculum (SRC) can improve resident satisfaction and research productivity.

Methods:
8 IM residents interested in cardiology were selected to participate in a 4-week elective focused on conducting systematic reviews and meta-analyses. Didactic lectures, online tutorials, and problem-based exercises were delivered by a multidisciplinary team of educators including a clinical researcher, librarian, and biostatistician.

Results:
Demographics are presented (Table 1). As compared to 16 residents that underwent traditional research electives, the SRC participants reported higher satisfaction, completed a mentored research project within 4 weeks, presented 4 posters at AHA annual meeting 2020, and finished manuscripts for publication (Figure 1).

Conclusions:
A focused research curriculum delivered by multidisciplinary educators is better than a traditional research elective and improves resident satisfaction.
Abstract 12339: Aggressive Additional Treatment Strategies to Eliminate Coronary Artery Aneurysms in Treatment-Resistant Kawasaki Disease
Authors: Yoshikane Yukako , Miyamoto Tatsuki , Ogawa ATsushi , Nagamitsu Shinichiro
Published: June 2023

Introduction:
Kawasaki disease (KD), which is the most common multisystem vasculitis with unknown causes in childhood, causes coronary artery aneurysms (CAAs) especially in treatment-resistant cases. Even with steroid combination therapy, sometimes the fever may persist or recur and requires several additional treatments, which cause CAAs. We reported previously about the scoring systems to predict non-responders to the initial steroid combination therapy. The aim of this study is to prove whether aggressive additional treatment strategies can prevent CAAs in patients at high risk of resistance to initial steroid combination therapy.

Methods:
The subjects were 39 KD patients with high scores in the scoring systems to predict non-responders to the initial steroid combination therapy*. *Patients who had high scores in all three predictive scoring systems in Japan, and scored 3 points or more in the following scoring system: Kobayashi scores ≥7, 2 points; Egami scores ≥4, 1 point; Number of neutrophils after initial treatment≥ 12000/μL, 2 points* Group 1 (n=26) received additional treatment after recurrent fever (ordinary strategy), Group 2 (n=13) received additional treatment before recurrent fever (aggressive strategy). We compared the incidence of CAAs (including transient dilatation) in each group.

Results:
In Group 1, there were 15 non-responders (58%) to the initial steroid combination therapy, compared to 0 in Group 2 (p<0.01). All of them had recurrent fever after resolving the fever once. The median day of recurrent fever was day 6 [5.3-7]. In Group 1, there were 5 patients (19%) who had coronary artery dilation greater than z-score >2.5 by treatment resistance, compared to 0 in Group 2 (p<0.01).

Conclusions:
The aggressive additional treatment strategies (intervention before recurrent fever) prevent CAAs in patients at high risk of resistance to initial steroid combination therapy. Even if the fever is relieved once in the initial treatment, it seems important to prevent recurrent fever around day 7 when histological changes begin in high-risk patients.
Abstract 12407: Hypothalamic-Pituitary Adrenal Axis Activation in Women With Takotsubo Syndrome
Authors: Salmoirago-Blotcher Elena , Tripolone Janice , Breault Christopher , Meyer Jerrold , Gathright Emily , Abbott J Dawn , Saltzman Adam , Lou Junyang , Burg Matthew
Published: June 2023

Introduction.
Takotsubo Syndrome (TS) has been associated with acute stress exposure and excessive activation of the adrenergic nervous system. Less is known about the role of chronic stress and of the hypothalamic-pituitary-adrenal (HPA) axis in the pathophysiology of TS. Hair cortisol concentration (HCC) is a novel biomarker of chronic stress and HPA axis activation. Plasma cortisol is incorporated in growing hair (average growth rate = 1 cm/month), reflecting HPA axis activity over the preceding months. In this study we measured HCC in TS patients and explored associations between HCC, trigger status, and psychological characteristics at enrollment.

Methods.
HCC was measured in a group of patients admitted with a new TS diagnosis based on Mayo Clinic criteria (n=18). Demographics, perceived stress, depression, anxiety, PTSD symptoms, coping skills, and resilience (self-report questionnaires); trigger history (standardized in-person interview); and HCC were collected at the baseline visit. Hair strands were cut near the scalp from a posterior vertex position. HCC was measured in the first 3 cm of hair, which reflects plasma cortisol levels during the previous 3 months. Samples were washed, ground, extracted in HPLC-grade methanol, and quantified (pg/mg) using a high-sensitivity enzyme immunoassay (EIA) kit. Descriptive statistics were used to characterize the sample, and Spearman rho to examine associations. A p value (2-sided) < .05 was considered significant.

Results.
Participants were 65.6 (SD 9.4) years old, 100% female, 100% white, 10% Hispanic. 52% married/living as married. Median HCC was 6.35 pg/mg (IQR 3.6, 15.2). HCC was significantly higher in patients reporting no triggers vs. those reporting a trigger prior to the TS episode (14.9 vs. 6.8 pg/ml, p=0.03). No associations were found between psychological measures and HCC, except for a non-significant inverse association between HCC and PTSD symptoms (rho=-0.35; p=0.14).

Conclusions.
This first exploration of HCC levels in patients with a recent TS episode suggests that chronic HPA axis activation likely does not play a role in the pathophysiology of TS. Findings need to be confirmed in a controlled study with a larger and more diverse sample.
Abstract 12420: Orally Inhaled Flecainide for the Conversion of Recent-Onset, Symptomatic Atrial Fibrillation to Sinus Rhythm: Final Results From the Phase 2 Instant Trial
Authors: Camm Alan J , Crijns Harry , Elvan Arif , Tuininga Ype , Badings Erik , Kuijper Aaf , de Jong Jonas , Lee Mark , Schellings Dirk , Van Gelder Isabelle C , Ruskin Jeremy N , Kowey Peter R , Dufton Christopher , Maupas Jean , Belardinelli Luiz
Published: June 2023

Introduction:
The INSTANT trial was a multicenter, open-label, single-arm study of flecainide acetate oral inhalation solution (FlecIH) for acute conversion of recent-onset, symptomatic atrial fibrillation (AF) to sinus rhythm (SR). The initial dose-ranging stage of the trial established safety and feasibility, while showing a dose- and concentration-dependent increase in efficacy (dose range: 30-120 mg); the highest dose was selected for this evaluation.

Methods:
Patients with symptomatic paroxysmal AF (≤ 48 hours) self-administered 120 mg FlecIH over 8 minutes in a monitored setting using a breath-actuated nebulizer and were continuously monitored for 90 minutes using a 12-lead Holter. Symptoms, vital signs and adverse events were recorded. Safety analyses included all patients who received 120 mg FlecIH (N=98). Efficacy analyses were performed on a modified intention to treat population (N=81) that excluded patients with systemic flecainide present prior to dosing with study drug.

Results:
The population had a mean age of 60.5 years, a mean BMI of 27.0 kg/m2 and 34.7% were female. All patients reported ≥1 AF-related symptoms at baseline and 87.8% presented with AF symptoms ≤ 24 hours in duration. The conversion rate was 46.9% (95% CI: 36.4%, 57.7%), with a median time of 13.7 minutes from the start of the inhalation. A greater proportion of patients were asymptomatic or had improved symptoms following conversion of AF to SR with inhaled flecainide compared to patients whose AF did not convert (92.1% and 45.4%, respectively, p < 0.001). Two patients had CV events that were considered serious (bradycardia and atrial flutter with 1:1 AV conduction). Both CV events were transient (12 and 6 minutes, respectively), required no treatment and resolved without sequelae. Median time to discharge was 2.5 hours for patients whose AF converted to SR with inhaled flecainide and by Day 5 none had experienced AF recurrence. In contrast, 35 (81.4%) patients in the no conversion group had undergone ECV by Day 5.

Conclusions:
The risk-benefit of orally inhaled flecainide acetate inhalation solution for acute cardioversion of recent onset AF appears favorable and may provide a safe, effective, and convenient first-line therapeutic option for AF conversion.
Abstract 12459: Hemodynamic Progression of Mitral Annular Calcification: Prevalence, Characteristics, and Clinical Implications
Authors: Lee Hee Jeong , Ha Kyungeun , Gwak Seo-Yeon , Kim Kyu , Ko Kyu-Yong , Cho Iksung , Hong Geu-Ru , Ha Jong-Won , Shim Chi Y
Published: June 2023

Background:
A recent study demonstrated that transmitral mean diastolic pressure gradient (MDPG) in patients with mitral annular calcification (MAC) is associated with increased mortality, however, the longitudinal hemodynamic progression over time in patients with MAC and its characteristics are unclear. In this study, the clinical and echocardiographic characteristics of MAC correlated with hemodynamic progression and its clinical implications were investigated.

Methods:
In total, 161 patients (mean age 74.7±10.5 yeas, 63 men) with MAC were identified by index transthoracic echocardiography (TTE) between January 2012 and June 2016 and performed follow-up TTE after 3 years. Stable MAC (n=146, 90.7%) was defined as a difference of transmitral mean pressure gradient (MDPG) less than 2 mmHg between initial and follow-up TTE, and progressive MAC (n=15. 9.5%) was defined as MDPG increased above 2mmHg.

Results:
There was no significant difference of baseline characteristics between the group with stable MAC and progressive MAC. In the group of progressive MAC compared to that of stable MAC, a proportion of moderate-to-severe MAC (66.7 vs. 28.1%,
p
=0.002), significant MS (26.7 vs. 8.2%,
p
=0.046), maximal thickness of MAC (0.7±0.5 vs. 0.5±0.3,
p
=0.023), and MDPG (2.8±1.7 vs. 2.2±1.5,
p
=0.048) were significantly higher at the index TTE (
Figure
). In the group with progressive MAC, increase in left atrial (LA) volume index and pulmonary artery systolic pressure were significant. In-5-year mortality and newly developed atrial fibrillation tended to be more common in progressive MAC group, but there was no statistical significance.

Conclusions:
Hemodynamic progression occurs in about 10% of patients over 3 years. Patients with progressive MAC have larger baseline MAC thickness and calcification extent, even if MDPG is less than 3 mmHg. Patients with progressive MAC are more likely to develop LA enlargement and pulmonary hypertension, which are prone to poor outcome.
Abstract 12460: Mobile Health Access And Usage, And Cardiovascular Risk: Results From The 2017-2020 Health Information National Trends Survey (HINTS)
Authors: Chen Yuling , Turkson-Ocran Ruth-Alma , Koirala Binu , Davidson Patricia , Commodore-Mensah Yvonne , Dennison Himmelfarb Cheryl R
Published: June 2023

Introduction:
There has been a rise in the interest in mobile health technology (mHealth) to support cardiovascular (CV) health; however, the relationship between CV risk and mHealth access/usage is not clear.

Methods:
We used data from the 2017 to 2020 Health Information National Trends Survey. CV risk factors examined included self-reported hypertension, diabetes mellitus, physical inactivity, current smoking status, and overweight/obesity. Multivariable logistic regression models examined the association between CV risk (we defined low, moderate, and high CV risk as having 0-1, 2-3, and 4-5 risk factors, respectively) and mHealth access/usage, adjusting for age, sex, race, education, income, etc. Analyses were stratified by age <65 and ≥65 years.

Results:
We included 16,092 adults (49% were male, 78% were aged <65 years, 63% were White, 45% had annual income <$50,000, 87% had at least one CV risk factor). In the full model (Table), compared to adults with low CV risk, those with moderate CV risk were more likely to use mHealth to make health decisions,
OR
1.27, 95% CI (1.10-1.46), track goal progress,
OR
1.22, 95% CI (1.07-1.41), share information with health providers (HP),
OR
1.59, 95% CI (1.33-1.90), and discuss with HP,
OR
1.27, 95% CI (1.10-1.46). Having high CV risk was associated with higher odds of mHealth access,
OR
1.56, 95% CI (1.08-2.25) and using mHealth to make health decisions,
OR
1.68, 95% CI (1.26-2.24), share information with HP,
OR
2.55, 95% CI (1.97-3.31), and discuss with HP,
OR
1.68, 95% CI (1.10-1.46). The associations remained significant among adults aged <65 years. Among adults aged ≥65 years, CV risk was only significantly related to sharing information with HP.

Conclusion:
Younger adults with higher CV risk were more likely to access mHealth and use mHealth to make health decisions, track goal progress, share information, and aid healthcare discussions. Our findings suggest the potential of using mHealth to facilitate CV risk reduction.
Abstract 12473: Assessing Disease Severity Using Machine-Learning of Baseline 12-Lead Ecg Parameters in Attr Cardiac Amyloidosis
Authors: Pimenta Dominic , Taubel Jorg , Anyim Martin , Gillmore Julian D , Zhu Tingting , Rezk Tamer
Published: June 2023

Introduction:
Cardiac amyloidosis accounts for 13% of all patients with heart failure with preserved ejection fraction (HFpEF). The National Amyloidosis Centre (NAC) scoring system (Stage 1-3), utilising eGFR and NT-proBNP correlates well with overall prognosis.

Hypothesis:
We wished to explore the feasibility of diagnosing disease severity using 12-lead ECG alone, using our database of >6,000 ECGs from 292 ATTR patients.

Methods:
Triplicate 12-lead ECG parameters (PR interval, QRS width, QT-interval, QRS morphology, axis, rhythm and low amplitude presence or absence), baseline NT-proBNP and baseline eGFR were extracted. Patients with pacing were excluded. For numeric baseline parameters, the mean triplicate ECG value was used. NAC stage was then calculated from eGFR and NT-proBNP (Stage 1: NT-proBNP <3000 AND eGFR >45, Stage 3: NT-proBNP >3000 and eGFR <45, Stage 2: meets neither stage 1 or 3 criteria). Data was assembled (Excel) and then machine learning models (multilayer perceptron, decision tree (DT), naïve bayes (NB), support vector machine and radius neighbours) were trained in a 80:20 split, with 5-fold stratified cross-validation (sklearn, Python 3.0) performed on the training set for tuning of hyperparameters, and the final model output performance measured on the separate test set. Performance was measured by F1 score.

Results:
295 patients were originally included, and 37 were excluded due to pacing, leaving 258 patients in the final dataset. On cross-validation the NB classifier performed best (F1 average 0.6) and the worst performing model was DT (F1 average 0.52). On the final test set the NB model performed as follows: Stage 1 NAC = F1 score 0.7, Stage 2 NAC = F1 score 0.45, Stage 3 NAC = F1 score 0.0.

Conclusions:
Despite the small dataset size, a machine learning approach could detect stage 1 disease with reasonable accuracy but struggled to differentiate between stage 2 and 3 disease. This model requires further external validation. We have demonstrated it is feasible to use a 12-lead ECG alone to diagnose stage 1 disease severity in ATTR-CM but not more advanced disease using machine learning.
Abstract 12518: Echocardiographic Features and Natural History of Right Ventricular Dysfunction in Cardiac Sarcoidosis With or Without Pulmonary Involvement
Authors: Sykora Daniel , Schmidt Tyler J , Elwazir Mohamed Y , Kolluri Nikhil , Chareonthaitawee Panithaya , Abou-Ezzeddine Omar F , Arment Courtney A , Bois John , Giudicessi John , Cooper Leslie T , Rosenbaum Andrew
Published: June 2023

Introduction:
Cardiac sarcoidosis (CS) is a non-ischemic disease which can present with right ventricular (RV) dysfunction, but there is a paucity of research describing RV function and natural history in CS.

Methods:
We queried a registry of 512 CS patients for those with baseline and follow-up echocardiography (TTE). Demographics, medications, and baseline/follow-up TTE data were collected. RV-pulmonary arterial (RV-PA) coupling was approximated by ratio of tricuspid annular plane systolic excursion to estimated pulmonary artery systolic pressure (TAPSE:ePASP).

Results:
Our query yielded 343 CS patients with mean age 56y (σ=12y), who were predominantly male (67%) and white (90%) with a median follow-up 4y (interquartile range 4.1y). Most had pulmonary sarcoidosis (68%). Baseline TTE data showed left ventricular ejection fraction 48% (σ=14), abnormal RV function with RV systolic pressure (ePASP) 34 mmHg (σ=11), TAPSE 21mm (σ=5), RV S′ 0.14 m/s (σ=0.07), and RV-PA uncoupling (TAPSE:ePASP 0.69 mm/mm Hg, σ=0.25). Baseline RV function parameters did not differ by pulmonary involvement of sarcoidosis. 92% received immunosuppression and 65% received neurohormonal blockade. In long-term follow-up, the overall cohort demonstrated a trend towards worsening of both RV S’ and RV-PA coupling (P=.02 and P=.003 for linear trend, respectively) but stable ePASP (P=.11). Trends in both non-invasive ePASP and RV-PA coupling were similar in patients with and without pulmonary involvement (P=.48 and P=.79, respectively).

Conclusions:
In our large CS cohort with extensive follow-up, metrics of RV function and RV-PA coupling are often abnormal at CS diagnosis. Echocardiographic measures of PASP tend to remain stable but markers of RV dysfunction, including RV-PA coupling, tend to worsen throughout the disease course irrespective of pulmonary sarcoidosis. More granular phenotyping of pulmonary hypertension in CS is required to better understand this relationship.
Abstract 12521: TMEM16 Antagonists Inhibit Phosphatidylserine-Induced Procoagulant Activity in Endothelial Cells and Protect From Thrombosis in vivo
Authors: Schmaier Alec A , Anderson Papa Freduah F , Chen Siyu F , Parikh Samir M , Flaumenhaft Robert C , Schulman Sol
Published: June 2023

Introduction:
Constitutively an anticoagulant surface, endothelial cells (ECs) switch to support coagulation following pathogenic stimuli, contributing to cardiovascular disease. To promote thrombosis, coagulation proteins must assemble on a membrane surface containing the anionic phospholipid phosphatidylserine (PS). PS is asymmetrically distributed on the inner leaflet of the plasma membrane but is rapidly externalized to the outer leaflet by calcium-activated phospholipid “scramblases”, such as TMEM16F. How phospholipid externalization on ECs supports coagulation and thrombosis has not been investigated.

Hypothesis:
We proposed that pharmacologic inhibition of TMEM16 phospholipid scramblases inhibits EC procoagulant activity and protects against thrombosis.

Methods and Results:
siRNA silencing of TMEM16F, and its closest paralog, TMEM16E, inhibited factor Xa generation and thrombin generation on the EC surface (60% and 90%, respectively,
p
< 0.0001), equivalent to the PS-binding protein lactadherin (100 nM). Two unrelated compounds with TMEM16 inhibitory activity, benzbromarone and CaCCinh-A01 (30 μM), prevented calcium-induced PS externalization on ECs, as determined by flow cytometry and immunofluorescence microscopy. These drugs did not inhibit intracellular calcium flux, suggesting they block the PS externalization activity of TMEM16. Benzbromarone and CaCCinh-A01 inhibited factor Xa generation on the EC surface in a dose-dependent manner (IC
50
3.2 μM and 2.0 μM, respectively). Thrombosis was evaluated using a laser injury model in the mouse cremasteric arteriole coupled with intravital microscopy to measure accumulation of fluorescently-labeled platelets and fibrin. Benzbromarone (5 mg/kg) inhibited platelet accumulation (
p
< 0.05) and fibrin formation (
p
< 0.01). Benzbromarone did not increase bleeding time in a tail-clip hemostasis assay.

Conclusions:
Activated ECs contribute anionic phospholipid to support coagulation, a process regulated by TMEM16 phospholipid scramblases. TMEM16 inhibition with benzbromarone protects from experimental thrombosis without resulting in excess bleeding. Benzbromarone is used worldwide to treat gout and could be repurposed for anti-thrombotic properties.
Abstract 12532: Impact of Autoimmune Hepatitis on Mortality and Outcomes of Hospitalized Patients Presenting Non-st-Segment Elevation Myocardial Infarction
Authors: Busari Olukayode , Fatuyi Michael , Akuna Emmanuel
Published: June 2023

Introduction:
Autoimmune hepatitis (AIH) is an inflammatory chronic liver disease disease when one’s immune system attacks the liver. Due to the widespread inflammatory response, we sought to evaluate the association between Autoimmune Hepatitis and mortality in patients hospitalized with Non-ST-Segment Elevation Myocardial Infarction (NSTEMI).

Methods:
Patients hospitalized for NSTEMI with and without AutoImmune Hepatitis between 2016 to 2018 were identified from the National Inpatient Sample. The primary outcome was all-cause mortality. The secondary outcomes were; Length of stay, total hospital charge and odds of requiring intra aortic balloon pump. A multivariable logistic regression analysis was used to adjust for in-hospital complications. A p-value of <0.05 was considered significant.

Results:
There were a total of 949,984 NSTEMI patients. Out of this number, 949,659 patients had NSTEMI without AIH, while 324.9 had NSTEMI with AIH. The mean age for NSTEMI without AIH was 68.2 years while the mean age for NSTEMI with AIH was 68.7 years. The odds of in-patient mortality in NSTEMI without AIH vs NSTEMI with AIH was 3.46% vs 4.62% respectively, (aOR= 1.5 , CI = 0.505 - 4.696, p = 0.76). The length of hospital stay (LOS) in NSTEMI without AIH vs NSTEMI with AIH was 4.58 days vs 4.66 days respectively, (CI = -1.016 - 1.223, P=0.18); and total hospital charges (THC) were $86,631 vs $81,851, ( CI = -23814 - 20432, P = -0.15). The odds of requiring intra aortic balloon pump (IABP) between NSTEMI without AIH vs NSTEMI with AIH was 2.49% vs 1.54% respectively, (aOR = 0.72, CI = 0.101 - 5.177).

Conclusions:
Patients with AutoImmune Hepatitis in the setting of NSTEMI did not have a difference in mortality or other clinical outcomes when compared with patients without AutoImmune Hepatitis. As with most observational studies, causality may not be confirmed due to potential residual confounding.
Abstract 12538: Intermittent Hypoxemia Progressively Destabilizes Ventricular Repolarization in Healthy Awake Subjects
Authors: Solhjoo Soroosh , Punjabi Naresh M , Siddharthan Trishul , Koch Abigail L , Crainiceanu Ciprian M , Haigney Mark C
Published: June 2023

Introduction
: Obstructive sleep apnea (OSA) is highly prevalent in the general population. OSA is associated with adverse cardiovascular events, including sudden cardiac death, but the mechanism is unclear. Intermittent hypoxemia, a pathognomonic feature of OSA, could increase the propensity for abnormal ventricular repolarization. We previously found that short-term exposure of awake healthy subjects to recurrent hypoxic episodes increased their heart rate (HR) and HR variability.

Hypothesis:
Exposure to intermittent hypoxia increases ventricular repolarization instability in awake healthy subjects.

Methods:
Healthy adults (N = 19) were exposed to either intermittent hypoxia or air for 4 hours on two different days in a randomized order. Intermittent hypoxia was induced with exposure to hypoxic gas (95% N
2
and 5% O
2
) or ambient air in an alternative fashion at a frequency of ⁓ 25 times/hour, mimicking moderate to severe OSA. Repolarization stability was assessed using the QT variability index (QTVI), a validated predictor of cardiac arrhythmias and mortality. HR and QTVI were measured from one-lead ECG over consecutive 5-min epochs. Paired sample
t
-
test was used to assess statistical associations.

Results:
Mean oxygen saturation levels were lower during exposure to intermittent hypoxia (90.86 ± 0.19%) versus normoxia (97.37 ± 0.20%, P < 10
-13
). Electrocardiographic measures at baseline were similar between the two conditions. No changes in these measures were noted during the conditions of normoxia. However, with intermittent hypoxia, mean HR and QTVI steadily increased (HR: 63.31 ± 1.51 initial, 69.21 ± 2.14 final, P < 0.001; QTVI: -1.85 ± 0.04 initial, -1.64 ± 0.07 final, P = 0.016). By the end of the 4-hour experiment, QTVI was greater in hypoxia vs. normoxia (final QTVI in hypoxia: -1.64 ± 0.07, in normoxia: -1.86 ± 0.06, P = 0.021).

Conclusion:
Four hours of intermittent hypoxia in awake normal healthy subjects progressively destabilized ventricular repolarization. Chronic exposure to recurrent periods of intermittent hypoxemia in OSA can increase ventricular repolarization and contribute to the OSA-associated adverse cardiovascular events, including sudden cardiac death.
Abstract 12558: Social Determinants of Health and 90-day Readmissions Among Pediatric Patients With Cardiac Disease
Authors: Fox Miriam T , Melvin Patrice , Alizadeh Faraz , Barreto Jessica A , Thiagarajan Ravi R , Ward Valerie , Moynihan Katie
Published: June 2023

Introduction:
Social determinants of health (SDoH) impact general pediatric readmissions and pediatric cardiac surgical mortality. Yet, little is known of their influence on readmissions in pediatric cardiac disease.

Hypothesis:
Children with cardiac disease from underrepresented populations, under-resourced neighborhoods or on public insurance are more likely to experience readmission.

Methods:
This was a multicenter retrospective study of patients <18 years with a cardiac diagnosis and index hospitalization with survival to discharge in the Pediatric Health Information System database (1/1/2017-12/31/2020). The outcome was 90-day all-cause non-elective readmission. SDoH examined were race/ethnicity, insurance type, income, and child opportunity index (COI; a composite variable of residential socioeconomic resources). Mixed effects multivariable logistic regression models were performed.

Results:
Of 249,222 cardiac-related admissions in 161,039 patients, 90-day readmissions were 55,770 (22.4%). Overall mortality was 2.8% (1.8% in readmissions). Clinical factors associated with readmission were infancy, non-surgical index admission, extracorporeal membrane oxygenation, greater length of stay, and non-cardiac comorbidities. Controlling for these factors, there was greater adjusted odds of 90-day readmission in patients with public or other insurance (vs private), Hispanic or Non-Hispanic Black race/ethnicity (vs Non-Hispanic White) and lower COI area residents (vs higher) [Table]. Sub-analysis in the 38,711 cardiac surgical admissions (15.8% 90-day readmission rate), found similar observations for race and insurance in adjusted analyses.

Conclusions:
Children with cardiac disease from under-resourced areas, underrepresented populations and/or on public insurance have higher odds of 90-day readmission. Our data provide insights for future interventions to optimize hospital discharge planning in this population.
Abstract 12578: Development and Validation of a Scoring System For Predicting Technical Failure During Percutaneous Coronary Interventions of Chronic Total Occlusions: The Updated PROGRESS-CTO Score
Authors: Karacsonyi Judit , Simsek Bahadir , Kostantinis Spyridon , Alaswad Khaldoon , Krestyaninov Oleg , Khatri Jai , Poommipanit Paul , Gorgulu Sevket , Jaffer Farouc A , KUTUZIS MICHAEL , Sheikh Abdul , Jaber Wissam , Rinfret Stephane , Yeh Robert , El Guindy Ahmed , GOKTEKIN OMER , Abi Rafeh, MD, FACC Nidal , Patel Taral , jefferson brian , Karmpaliotis Dimitrios , Kirtane Ajay , McEntegart Margaret , Mastrodemos Olga , Rangan Bavana V , Ungi Imre , Sandoval Yader , Allana Salman S , Burke M Nicholas , Brilakis Emmanouil S
Published: June 2023

Background:
Predicting technical failure in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can assist with decision making and planning of the procedure.

Methods:
We analyzed 6,946 CTO PCIs performed between 2016 and June 2022 at 36 international centers in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) and created a score for risk of technical failure. Logistic regression prediction modeling was used to identify independently associated variables with technical failure and model were internally validated with bootstrapping.

Results:
Mean patient age was 64.0±10 years, 82% were men and technical success was 86%. The following variables were independently associated with technical failure and were included in the final model: age (odds ratio [OR]: 1.08, 95% Confidence Intervals [CI]: [1.00-1.15], p=0.039; age≥ 65 years; 1 point), CTO length (OR: 1.13, 95% CI [1.10, 1.17]; length≥ 20 mm; 1 point), moderate/severe calcification (OR: 1.35, 95% CI [1.17, 1.56]; 1 point), proximal cap ambiguity (OR: 2.25, 95% CI [1.95, 2.59]; 2 points), lack of interventional collaterals (OR: 1.60, 95% CI [1.39, 1.84]; 1 point), and lack of good distal landing zone (OR: 1.51, 95% CI [1.31, 1.75]; 1 point). The resulting score showed acceptable performance on receiver-operating characteristic (ROC) curve, AUC: 0.68 (95% CI [0.67-0.71]). Internal validation with bootstrapping of 1000 samples demonstrated a good agreement with the model, observed AUC: 0.68, (95% bias corrected CI [0.67, 0.70]). PROGRESS-CTO technical failure score and corresponding risk percentage and the percentage of patients in the respective risk group within the PROGRESS-CTO registry are represented in Figure 1.

Conclusion:
The updated PROGRESS CTO score may be useful for assessing the likelihood of technical failure success in CTO PCI.
Abstract 126: The Association Of Higher Or Lower Mean Arterial Pressure On Kidney Function After Cardiac Arrest: A Post-hoc Analysis Of The Comacare And Neuroprotect Trials
Authors: Laurikkala Johanna , Ameloot Koen , Reinikainen Matti , Palmers Pieter-Jan , Bogaerts Eline , De Deyne Cathy , Bert Ferdinande , Dupont Matthias , Janssens Stefan P , Dens Joseph , Hastbacka Johanna , Jakkula Pekka , Loisa Pekka , Birkelund Thomas , Wilkman Erika , Vaara Suvi , Skrifvars Markus B
Published: June 2023

Introduction:
Acute kidney injury (AKI) denotes a sudden reduction in kidney function manifested by a rise in S-creatine levels and reduced urine output. Studies have suggested an association between AKI severity and outcomes after OHCA. Various criteria have been used to define AKI, the Kidney Disease Improving Global Outcomes (KDIGO) published in 2012 being the currently used tool. AKI is a feature of post-cardiac arrest syndrome.During post-CA syndrome, possible causes of renal damage are direct renal ischaemic-reperfusion injury and indirect renal damage characterized by the activation of inflammatory and coagulation pathways. Although the overall mortality rate after CA mainly relates to hypoxic-ischaemic brain injury, damage to other organs also has prognostic implications.

Methods:
Pooled post-hoc analysis of the COMACARE (NCT02698917) and NEUROPROTECT (NCT02541591) trials that randomized patients to lower (MAP 65-70 mmHg) or higher (MAP 80-100 mmHg) targets for the first 36 hours of post-CA intensive care. Kidney function was categorised using the KDIGO classification during the first five days after OHCA. We used Cox regression analysis to identify factors associated with AKI after OHCA.

Results:
A total of 227 patients were included: 115 in the high MAP group and 112 in the low MAP group. Eighty-six (38%) patients developed AKI during the first five days; 40 (47%) patients had AKI in the high MAP group and 46 (54%) in the low MAP group (p = 0.51). The mean creatinine and mean daily diuresis were 104 (95% CI 94-115) μmol/l and 1989 (95% CI 1829-2150) mL/day in the high MAP group and 111 (95% CI 99-122) μmol/l and 1677 (95% CI 1530-1824) mL/day in the low MAP group. In a Cox regression model, independent AKI predictors were previous hypertension (HR 1.72; 95% CI 1.07-2.78; p = 0.03), bystander cardiopulmonary resuscitation (hazard ratio [HR] 0.46; 95% CI 0.29-0.73; p < 0.01), shockable initial rhythm (HR 0.36; 95% CI 0.21-0.61; p ≤ 0.01), and time to ROSC (HR 1.04; 95% CI 1.02-1.06; p < 0.01) whereas high/low MAP was not an independent predictor of AKI.

Conclusions:
KDIGO1-staged AKI is common after CA and is associated with previous hypertension and CA factors. Targeting higher MAP after CA does not appear to influence the development of AKI.
Abstract 127:

Urine Output And Mortality In Patients Resuscitated From Out Of Hospital Cardiac Arrest
Authors: Sarma Dhruv , Kashani Kianoush , Jentzer Jacob C
Published: June 2023

Background:
Urine output (UO) measurement utility after out-of-hospital cardiac arrest (OHCA) survivors who undergo targeted temperature management (TTM) is not well understood.

Methods:
We included 247 comatose adult patients who underwent TTM after OHCA between 2007 and 2017 and excluded those on maintenance dialysis. Groups were defined based on mean hourly UO during the first 24 hours: Group 1 (<0.5 ml/kg/hr, n=73), Group 2 (0.5-1 ml/kg/hr, n=81) and Group 3 (>1 ml/kg/hr, n=93). Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria were used to define and stage acute kidney injury (AKI). Multivariable analysis was used to evaluate in-hospital mortality.

Results:
In-hospital mortality decreased as 24-hour mean UO increased (56.2% [41/73] vs 29.6% [24/81] vs 18.3% [17/93] in Groups 1, 2 and 3, respectively; adjusted OR 0.93 per 0.1 ml/kg/h higher, 95% CI 0.87-0.99, p = 0.03), and UO < 0.5 ml/kg/hr was strongly associated with in-hospital mortality (adjusted OR 4.2 [1.6-10.8], p=0.003). In-hospital mortality varied by the KDIGO stage and UO group (Figure), lowest in KDIGO stage 0 and highest in KDIGO stage 3. Both UO (adjusted OR 0.92 per 0.1 ml/kg/h higher, p = 0.002) and KDIGO stage (adjusted OR 1.62 per each stage, p = 0.002) were associated with in-hospital mortality when included in the same model. Among patients with KDIGO stage 0, lower UO portended higher mortality (Figure). Likewise, among patients with low UO (group 1), a higher KDIGO stage predicted higher mortality.

Conclusion:
Amongst OHCA survivors undergoing TTM, higher UO is incrementally associated with lower in-hospital mortality. The lowest mortality was observed at UO >=1 ml/kg/h, suggesting this as a target for resuscitation in OHCA patients undergoing TTM. Low UO remains associated with in-hospital mortality even when accounting for AKI by creatinine criteria, suggesting that oliguria is a more sensitive prognostic marker in the early post-OHCA phase.
Abstract 12772: Transcatheter Aortic Valve Replacement Improves Functional and Quality Of Life Outcomes in Patients With Low Gradient Aortic Stenosis
Authors: Danley Kelsey , Brandon Margaret , Chiang Caleb , Luo Shengyuan , Derbas Laith A , Collado Fareed M , Kavinsky Clifford J , Suradi Hussam S
Published: June 2023

Introduction:
Aortic stenosis (AS) is the most common valvular disease, and severe disease can significantly impact morbidity. Less data exists examining the functional and quality of life (QOL) effects of transcatheter aortic valve replacement (TAVR) in patients with severe low-gradient AS in both low-flow and normal-flow states.

Hypothesis:
Patients with symptomatic, severe, low-gradient AS would have improvements in functional and QOL outcomes at 30-days and 1-year following TAVR procedures.

Methods:
A single center, retrospective study examined symptomatic, severe, low-gradient AS variants. These had an aortic valve area of ≤1.0 cm
2
, mean transvalvular gradient <40 mmHg, and peak aortic valve velocity of <4 m/s. Classical low-flow low-gradient (CLFLG) AS was defined as a left ventricular ejection fraction (LVEF) <50%. CLFLG group underwent dobutamine stress echo to assess AS severity (Stage D2). Paradoxical low-flow low-gradient (PLFLG) AS was defined as LVEF ≥50% and a stroke volume index (SVi) ≤35mL/m
2
(Stage D3). Normal-flow low-gradient (NFLG) AS was defined as LVEF ≥50% and SVi >35mL/m
2
(Stage D4). The primary outcome was change in New York Heart Association (NYHA) classification and a 12-item Kansas City Cardiomyopathy Questionnaire overall score (KCCQ-OS) at 30-days and 1-year following TAVR.

Results:
A total of 191 patients were included for analysis: 46 CLFLG, 83 PLFLG, and 62 NFLG AS. At baseline, 130 (68%) had NYHA class III or IV symptoms. Mean baseline KCCQ-OS for all groups was 38±23 (Figure 1). The mean KCCQ-OS at 30-days and 1 year were 62±22 and 68±20. There were no significant differences in KCCQ-OS between the groups at 30-days and 1-year. Following TAVR, 92% and 88% of the cohort had NYHA class I or II symptoms at 30-days and 1 year.

Conclusions:
Patients with symptomatic, severe low-gradient AS had significant and sustained improvements in their functional and QOL metrics at 30-days and 1-year following TAVR procedures regardless of flow-state.
Abstract 12828: Association of Neighborhood Characteristics With Outcomes in Patients With Atrial Fibrillation in a Large Midwest Community
Authors: Chamberlain Alanna M , Alonso Alvaro , Siontis Konstantinos , Noseworthy Peter A , Manemann Sheila M , Weston Susan , Killian Jill , Ryu Euijung , Roger Veronique L
Published: June 2023

Background:
The communities in which people live affect their health. We aimed to determine whether neighborhood characteristics are associated with outcomes in patients with atrial fibrillation (AF) in a Midwest community.

Methods:
Patients with incident AF from 2013-2017 from a 27-county region who survived >90 days after their diagnosis were identified (N=14,725). Patient addresses were linked to publicly-available data on population density (rural-urban commuting area; RUCA) and neighborhood socioeconomic status (area deprivation index; ADI). Patients were followed for ischemic stroke or transient ischemic attack (TIA), heart failure (HF), dementia/delirium, and all-cause death through 2021. Cox regression determined risk of outcomes by RUCA category (urban, micropolitan, small rural, isolated) and ADI quartile after adjustment for age, sex, race/ethnicity, and CHA2DS2-VASc score.

Results:
After excluding persons missing race/ethnicity (n=46), RUCA (n=1,465), and ADI (n=1,640), 13,233 patients with AF (mean age 73.8 years, 57% men) remained. After a median follow-up of 4.7 years, 5,989 patients died; 582 experienced a stroke/TIA, 4,122 (of 9,156 patients at risk) developed HF, and 1,758 (of 12,154 patients at risk) developed dementia/delirium. Persons living in isolated areas (HR 1.14, 95% CI 1.05-1.24) and the highest ADI quartile (HR 1.59, 95% CI 1.37-1.85) experienced the greatest risk of death (Figure). A trend toward an increased risk of HF was observed for the 2 highest ADI quartiles (p-trend <0.01), although the estimates did not reach statistical significance. The risk of other outcomes did not differ by RUCA or ADI category.

Conclusion:
Patients with AF residing in isolated areas and neighborhoods with greater area deprivation experience increased risks of death. Additional research is needed to better understand how neighborhood characteristics influence treatment, co-morbid conditions, and other outcomes in patients with AF.
Abstract 12836: Cardiovascular Disease Profile in Children With Hcm (aspire-hcm): A Canadian Cross-Sectional Study
Authors: Conway Jennifer , Pidborochynski Tara , Khoury Michael , DHILLON Santokh S , Vaujois Laurence , Dallaire Frederic , Armstrong Kathryn , Schantz Daryl , Mawad Wadi , Alami Laroussi Nassiba , Bradley Timothy J , Jeewa Aamir
Published: June 2023

Introduction:
Adults with hypertrophic cardiomyopathy (HCM) have been shown to have abnormal cardiovascular (CV) health, leading to long-term problems. However, little is known about the CV health of children with HCM. Given the emphasis placed on physical activity restrictions in patients with HCM, effective communication regarding the importance of a heart-healthy lifestyle may be lacking. Therefore, the aim of this study was to assess CV health in a cohort of children with HCM across Canada.

Methods:
Children with HCM, ages 10-18 years old, were recruited from 10 Canadian sites and underwent CV health screening including: body mass index (BMI), central adiposity assessment via the waist-to-height ratio (WHtR, ≥0.5 considered abnormal), non-fasting lipid profile, (abnormal cholesterol being >4.4 mmol/L); systolic blood pressure (≥95th percentile considered hypertensive;0 and a 2-week period of activity assessment using a wrist Fitbit. An average daily step count ≥12,500 was used as a surrogate for ≥60 minutes of moderate to vigorous physical activity.

Results:
Forty-six patients with HCM were included [76% male; median age 15.4 years (IQR 13.7, 16.7)]. The median BMI percentile was 85.0 (IQR 58.5, 97.0) with 56.6% being overweight or obese (BMI >85th percentile). The WHtR was a median of 0.51 (IQR 0.43-0.55), with 55.6% being ≥0.50. The median systolic blood pressure was 113.5 mmHg (IQR 101.8-123.0), with 10.8% having measurements in the hypertensive range. The median cholesterol was 3.7 mmol/L (IQR 3.4-4.4), with 29% of patients having an elevated cholesterol. Average daily step count ≥12,500 occurred in 14% of the cohort with the median average steps per day being 7,590 (IQR 5,205-10,894).

Conclusions:
The majority of Canadian children with HCM have evidence of physical inactivity and an adverse CV risk profile. In order to prevent poor CV health outcomes in adulthood, interventions are required to target these risk factors in children with HCM.