bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14843: Unveiling the Phenotype of Smooth Muscle Foam Cells in Human Atherosclerotic Lesions: Insights From Bulk and Single Cell RNA Sequencing
Authors: Allahverdian Sima , Xiang Pinhao , Blanchard Valentin , Sahin Basak , Chan Teddy , Francis Gordon A
Published: December 2023

Background and Aims:
Our previous studies of human coronary atherosclerosis and ApoE-/- mice indicated that at least 50% and ~70% of foam cells are of smooth muscle cell (SMC) origin, respectively. We also found that SMCs generate a distinct class of foam cells, due to several gene expression and regulatory differences compared to macrophage foam cells. In the current investigation we utilized transcriptomic approaches to identify and characterize the phenotype of SMC foam cells of human coronary plaques and in SMCs treated with aggregated LDL (ag-LDL).

Methods:
Sections of fresh human coronary artery were subjected to gentle digestion and the isolated cells used for single-cell RNA Sequencing (scRNA-Seq) (n=3) using 10X Genomics Chromium Single Cell 3’ Reagent Kits v3 Technology. Human vascular SMCs were treated with 100 μg/mL ag-LDL for 24 h (n=3) and stained with the fluorescent lipid probe BODIPY493/503. BODIPY
high
SMCs were collected and subjected to bulk RNA sequencing along with non-treated SMCs as control.

Results:
Single cell RNA sequencing of cells isolated from human coronary arteries followed by unsupervised Seurat-based clustering (R version 4.2.0) identified 15 distinct clusters including 8 SMC clusters with varying degrees of differentiation and macrophage foam and non-foam cells. The top 70 upregulated genes in ag-LDL treated SMCs were used to identify clusters corresponding to SMC foam cells in the scRNA-seq dataset. We found that these genes are mostly enriched in 2 clusters of less differentiated SMCs. SMC and macrophage foam cell clusters display distinct characteristics. SMC foam cell clusters exhibit upregulation of complement and coagulation cascades, as well as ECM-receptor interaction genes. In contrast, the macrophage foam cell cluster shows enrichment of proinflammatory genes, genes involved in the response to unfolded protein, and both pro- and anti-apoptotic genes.

Conclusion:
Our studies provide novel tools to investigate the nature of SMC foam cells in human atherosclerosis and may provide unique markers for SMC foam cells. Gaining a comprehensive insight of the significance and characteristics of SMC foam cells is crucial in elucidating their ultimate role and potential as a therapeutic target in atherosclerosis.
Abstract 14844: Coronary Artery System Dominance Influences the Distribution of Calcified Plaques in Coronary Tree
Authors: Pourafkari Leili , Kinninger April , Manubolu Venkat Sanjay , Fazlalizadeh Hooman , Ichikawa Keishi , Aldana Jairo , Roy Sion , Budoff Matthew J
Published: December 2023

Introduction:
Left dominant coronary system associates with worse prognosis likely due to less well-balanced myocardial perfusion. Larger proportion of coronary flow enters left coronary in left dominant systems potentially leading to higher shear stress. In left dominant coronary systems, resultant alterations in flow hemodynamics could affect development of calcified plaques in left anterior descending artery (LAD).

Hypothesis:
Coronary artery dominance with resultant alterations in blood flow hemodynamics in coronary arteries could affect the distribution of calcified plaques in the coronary tree

Methods:
We performed a large retrospective single-center cohort study, including consecutive patients who underwent CTA from September 2006 to December 2022 in Los Angeles, California to determine whether left dominant coronary anatomy was associated with higher LAD calcium percentage (LAD calcium score divided by total calcium score) compared to right dominant coronary system. Subjects with coronary artery calcium score (CAC) above zero were enrolled. Multivariable linear regression was used to evaluate the association between the LAD calcium percentage by subjects with left versus right coronary system dominancy.

Results:
Among the cohort of 9,560 subjects,6,796 subjects had with CAC above zero. The average age was 64.8±10.7 years, 68% male, and 9% had left dominant coronary systems. Controlling for age, gender, BMI, hyperlipidemia, hypertension, family history of cardiovascular disease and past smoking, those with a left dominant coronary system had 10.1% higher (CI 7.5%-12.8%, p<0.001) percent of calcium localized in LAD than those with right dominant systems (Table 1)

Conclusions:
Coronary system dominance affects the distribution of atherosclerotic burden. Left dominant coronary system compared to right dominant coronary system is associated with higher percentage of calcified plaques localized to LAD.
Abstract 14868: Association Between Social Vulnerability Index and Cardiovascular Disease Outcomes Among New York State Counties
Authors: Gonzalez Negrete Eduardo , Chang Ko-Yun , Li Cheng-Chen , Thapar Raj , Tameez Ud Din Asim , Pandya Prakruti , Chan Shu-Yen , Abdu Manasik , Parashar Akash , Chrzanowski Stephen G , Lee Yu-Che
Published: December 2023

Introduction:
Cardiovascular disease (CVD) is the leading cause of death and poses a significant economic burden in the USA. Social Vulnerability Index (SVI) is a tool developed by the Centers for Disease Control and Prevention (CDC) to assess social vulnerability to disasters. The relationship between SVI and CVD outcomes in New York State (NYS) has not been explored. Our aim is to examine the association between county-level SVI and CVD hospitalization and mortality rates in NYS.

Methods:
Hospitalization and mortality rates for CVD and its subtypes (heart diseases, coronary heart disease, heart attack, congestive heart failure, and stroke) between 2016 and 2018 were obtained from the NYS Community Health Indicator Reports. The SVI is based on 4 subindices: Socioeconomic Status, Household Composition & Disability, Minority Status & Language, and Housing Type & Transportation. Higher SVI indicates greater vulnerability. We examined the CDC SVI 2018 data for NYS. The associations between CVD and its subtypes outcomes and SVI and its 4 subindices were analyzed by negative binomial regression.

Results:
Among counties, Bronx had the highest SVI (most vulnerable) and Saratoga had the lowest SVI (least vulnerable). Counties with higher SVI were associated with worse CVD outcomes. (hospitalization, incidence rate ratio [IRR]: 1.205 [95%CI: 1.035-1.402], per 1-unit increase; mortality, 1.201 [1.093-1.320]). Regarding the 4 subindices, Socioeconomic Status and Household Composition & Disability were independently associated with CVD mortality (1.137 [1.000-1.292] and 1.201 [1.066-1.354]). Minority Status & Language was independently associated with CVD hospitalization. (1.344 [1.130-1.599]).There was no association between Housing Type & Transportation and CVD outcomes.

Conclusions:
County-level SVI was associated with CVD outcomes in NYS. This underscores the need for improved prevention strategies and targeted interventions for CVD in vulnerable areas.
Abstract 14873: Takotsubo Syndrome and Surgery: A Systematic Review
Authors: Li Pengyang , Dobbin Travis , CAI Peng , Shi Ao , Liu Qi
Published: December 2023

Background:
Takotsubo syndrome (TTS) is a rare cardiovascular condition characterized by reversible ventricular dysfunction. An increasing number of studies have shown surgery as a trigger for TTS.

Methods:
We performed a systematic review of all case reports and case series reporting an association between surgery and TTS by searching PubMed, EMBASE, and Cochrane Library databases in June 2022. A total of 172 cases (Surgery-TTS) were selected and compared with previously reported 1,750 TTS patients of any type (All-TTS).

Results:
In TTS patients triggered by surgery, the most common symptom was dyspnea (48.6%), followed by chest pain (31.8%) and dizziness (4.7%). The most common type of TTS was apical, accounting for 80.4% of cases, followed by the basal (8.2%), biventricular (5.1%), and midventricular (3.8%) types. Among these cases, 46.5% were associated with intraabdominal procedures, 25% with cardiothoracic surgery, followed by 12.3% with ENT/Ophthalmology and 8.7% with neurosurgery. Compared with the All-TTS cohort, the Surgery-TTS cohort was younger (55.9 vs 66.4, P < 0.001) and had a lower incidence of chest pain (75.9% vs. 31.8%; P < 0.001) and QT prolongation (18.0% vs. 47.7%, P < 0.001) but a significantly increased in-hospital mortality (10.4% vs 4.1%, P = 0.001). Furthermore, basal-type TTS was significantly more common in the Surgery-TTS cohort than in the All-TTS cohort (8.2% vs. 2.2%, P < 0.001).

Conclusions:
Surgical triggers are associated with increased mortality and atypical presentation in TTS patients when compared with patients who have TTS of all types. A high degree of clinical suspicion is required to concurrently diagnose TTS in surgical patients.
Abstract 14874: Trends and Disparities in Cardiovascular Death in Colorectal Cancer: A Population-Based Retrospective Study in the United States From 1999 to 2020
Authors: Ekmekjian Zareh , Tan Min Choon , Kiwan Chrystina , Tan Min Xuan , DACOSTA THEODORE R , walia jasjit , Mazzarelli Joanne , Suleiman Addi
Published: December 2023

Background:
Overlap between cardiovascular diseases and colorectal cancer(CRC) has become more prominent with enhanced life expectancy. The data on cardiovascular deaths (CVDs) among those patients is not well-established.

Objective:
This study sought to determine the longitudinal trends in mortality attributed to CVDs with comorbid CRC by race, sex, and region.

Methods:
We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database and performed serial cross-sectional analyses of national death certificate data for CVDs with comorbid CRC among patients aged 18 and above. Diseases of the circulatory system were listed as the underlying cause of death, and colorectal cancer as contributing cause of death. We calculated age-adjusted mortality rates (AAMR) per 1,000,000 individuals and determined the trends by using the Joinpoint Regression Program.

Results:
In the 22-year study period, 77,094 CVDs with comorbid CRC were identified between 1999 and 2020. The AAMR from CVDs with comorbid CRC decreased significantly from 29.73 per 1,000,000 individuals in 1999 to 9.65 per 1,000,000 individuals in 2020 (p<0.05). The most common CVDs reported were ischemic heart disease (56%) and cerebrovascular disease (14%). Males had a higher AAMR compared to females (21.51 vs 12.53 per 1,000,000 individuals, p<0.05). African Americans had the highest AAMR (18.12 per 1,000,000 individuals), while the AAMRs for White populations, American Indian, and Asian populations were 16.28, 9.09, and 9.06 respectively. Rural areas had a higher AAMR than urban areas (18.25 vs 15.76 per 1,000,000 individuals, p<0.05).

Conclusion:
The CVDs in patients with CRC have decreased significantly over the past two decades, with disparities seen in African Americans and rural regions. This highlights the importance of early screening among high-risk populations, and the importance of improving healthcare access in underserved populations.
Abstract 14876: Characterizing Regional and Global Effects of Epicardial Adipose Tissue on Left Atrial Function
Authors: Noorbaksh Ali A , Reddy Shiva , Shankar Aditi , MacNamara James P , Hearon Christopher M , Levine Benjamin D , Sarma Satyam
Published: December 2023

Background:
Obesity is associated with left atrial (LA) dysfunction. Excess epicardial adipose tissue (EAT) deposition is one potential mechanism for this dysfunction. However, it is unknown if the effects of EAT on LA function are mediated via adjacency to LA tissue or rather, represent effects of generalized cardiometabolic dysfunction, also common in obesity. We hypothesized EAT located around the LA would be associated with LA function compared to EAT located distally on the left ventricle (LV).

Methods:
ardiac MRI was performed in 54 middle-aged obese adults (n = 80, age 40-55 yrs) enriched for increased heart failure risk (N-terminal pro-B-type natriuretic peptide >40 pg/mL or high-sensitivity cardiac troponin T >0.6 pg/mL; visceral fat >2kg). EAT was quantified by tracing the area of LV EAT depots on short axis and LA EAT depots on long axis. LA strain was assessed by MRI feature tracking as reservoir strain during LV systole, conduit strain during early LV diastole, and contractile strain during late LV diastole. Linear regression was performed between EAT area and LA strain components. LA function was quantified by LA reservoir, conduit, and contractile strain.

Results:
LV EAT amount was 12 times higher than LA EAT (66.7 vs 5.3 cm
2
). LA EAT was associated with decreased LA conduit strain (r = 0.37, 95% CI = 0.12 to 0.58, p = 0.006) and a trend towards lower reservoir strain (r = -0.26, 95% CI = -0.49 to 0.01, p = 0.058). There was no association with contractile strain. There were no relationships between LV EAT and LA function.

Conclusion:
Increased LA EAT was associated with worse LA strain. In contrast, LV EAT had no demonstrable effect on LA strain. Our results suggest LA EAT may have direct mechanical or paracrine effects on atrial tissue function and may be a therapeutic target for improving LA function in obese patients.
Abstract 14885: Updated Meta-Analysis of 1 Month versus Greater Than 1 Month of Dual Anti-Platelet Therapy (DAPT) After Percutaneous Coronary Intervention Supports Shorter DAPT Duration
Authors: Mirza Jibran M , Sharma Arjun K , Nafee Tarek , Lin Chien-Jung
Published: December 2023

Introduction:
The ideal duration of dual anti-platelet therapy (DAPT) after percutaneous coronary intervention (PCI) remains elusive, a balancing act between bleeding and ischemic risks. Recent evidence suggests a shorter duration may be safe. This updated meta-analysis evaluates the safety and efficacy of 1 month of DAPT in patients after PCI with a drug eluting stent.

Hypothesis:
1 month of DAPT will be more favorable than greater than 1 month of DAPT

Methods:
This meta-analysis reviewed literature obtained systematically. Inclusion criteria encompassed randomized study designs comparing the efficacy of 1-month DAPT versus greater than 1-month of DAPT treatment in patients with PCI for stable coronary artery disease (CAD) or acute coronary syndrome (ACS), minimum follow-up of 12 months, and full-text studies published in peer-reviewed journals. Exclusion criteria include studies that did not include DAPT longer than 1-month, non-randomized studies, unpublished studies, and ongoing trials. We reviewed 96 articles; 7 were included in our meta-analysis. We included 2 more studies compared to the most recent meta-analysis. Our statistical analysis calculated weighted pooled risk ratios, confidence intervals, and p-values using the Mantel-Haenszel method.

Results:
The sample size was 24,412. The primary outcome of overall mortality favored 1 month of DAPT compared to greater than one month DAPT [RR 0.57, (CI 0.48-0.66) P<0.00001]. The secondary outcomes of cardiovascular death [RR 0.68, (CI 0.56-0.83) P=0.0001] and bleeding [RR 0.70, (CI 0.63-0.78) P<0.00001) favored 1 month of DAPT compared to greater than 1 month of DAPT. The secondary outcome of myocardial infarction [RR 1.25, (CI 1.08-1.44) P=0.002] favored greater than 1 month of DAPT compared to 1 month of DAPT. Stent thrombosis [RR 1.21, (CI 0.84-1.74) P= 0.31] did not meet statistical significance.

Conclusions:
Our meta-analysis suggests that 1 month of DAPT was associated with improved overall mortality, cardiovascular death and bleeding, at the expense of increased myocardial infarction. One month of DAPT is a reasonable treatment option for high bleeding risk patients undergoing PCI.
Abstract 14915: Role of Diabetes and Diabetic Medication in Cardiovascular Events and Survival Among Older Men With Prostate Cancer on Androgen Deprivation Therapy: Longitudinal SEER Medicare Analysis
Authors: Nain Priyanshu , Datta Biplab , Jiang Stephanie , Patel Vraj , Seth Lakshya , Bhave Aditya , Malik Sarah , Nettles Darryl , Gong Yan , Fradley Michael , Leong Darryl , Weintraub Neal L , Guha Avirup
Published: December 2023

Introduction:
The effect of diabetes mellitus (DM) and DM therapy on cardiovascular events (CVE) in patients with prostate cancer (PC) undergoing androgen deprivation therapy (ADT) is unclear in the contemporary era.

Methods:
Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, we identified males ≥ 66-year-old with a new primary diagnosis of PC undergoing leuprolide therapy (ADT) between 2009-2017. These patients were followed for two years to identify a primary outcome of CVE that included heart failure (HF), atrial fibrillation (AF), acute myocardial infarction (AMI), peripheral artery disease (PAD), coronary artery disease (CAD), ischemic stroke (IS) and cardiovascular death. DM medications identified using part D data for this analysis were metformin, insulin, and other orals based on FDA approval dates until 2017. Adjusted Cox proportional hazards modeling was performed to estimate all-cause mortality in PC patients stratified by DM and among those with DM and on different therapies. Adjusted Fine-Gray modeling with appropriate competing risk (mortality or type of mortality) was utilized for other outcomes as presented. We adjusted for demographic factors, social determinants of health, cancer-specific factors, and other cardiovascular risk factors apart from the primary exposure of DM.

Results:
This study included 9,072 PC patients. Among these 2,822 (31.1%) had DM, and 5,105 (56.3%) had cardiovascular disease prior to PC diagnosis. New CVE was diagnosed in 619 (6.8%; HF = 144, AF = 107, AMI = 40, PAD = 132, CAD = 226, IS = 66) patients in a 2-year period after the PC diagnosis. DM was noted to be a risk factor for CVE [adjusted subdistribution hazards ratio (aSHR) = 1.22 (95% CI= 1.07-1.44)]. The effect of DM and DM medication on mortality is presented in
Table 1.

Conclusion:
PC patients on ADT with DM have a higher risk of CVE and all-cause mortality. Metformin use is associated with reduced all-cause mortality.
Abstract 14917: The Influence of Coronary Artery Disease on Cerebrovascular Reactivity and Cognitive Function
Authors: Taylor Jenna L. , Buskard Andrew N , Webb Kevin L , Donkor Joshua D , Johnston Jessica I , Bonikowske Amanda R , Stricker Nikki H , Barnes Jill N , Johnson Bruce D
Published: December 2023

Introduction:
Patients with coronary artery disease (CAD) are at increased risk of cognitive decline. A proposed mechanism is cerebral hypoperfusion related to vascular dysfunction and impaired cerebral blood flow regulation

Hypothesis:
Patients with CAD will have lower cerebrovascular function than age- and sex-matched controls, assessed as reactivity to a vasodilatory carbon dioxide (CO
2
) stimulus.

Methods:
Adults 40-70years old with CAD were recruited on enrollment to a cardiac rehabilitation program following a cardiac event or hospitalization. Age and sex-matched adults without known disease or cardiovascular risk factors were recruited as healthy controls. Cognitive function was assessed by the Fluid Composite of the NIH Cognition Toolbox. Following a familiarization visit, participants underwent a stepped CO
2
protocol (room air, 2% CO
2
, 4% CO
2
, 6% CO
2
) while continuously measuring middle cerebral artery velocity (MCAv) using transcranial doppler ultrasound, mean arterial pressure (MAP), ventilation (VE), and end-tidal CO
2
. Cerebrovascular conductance (CVCi) was calculated as MCAv/MAP. Cerebrovascular reactivity was calculated as the linear regression slope of CVCi against the change in end-tidal CO
2
. The reactivity of MAP and VE (or chemosensitivity) were also calculated.

Results:
19 patients with CAD and 10 healthy controls were recruited (
Table 1
). Compared with controls, patients with CAD had a 2-fold lower cerebrovascular reactivity (p=0.003), higher MAP reactivity (p<0.05), and a trend towards higher chemosensitivity (p<0.1) (
Table 2
). There were no group differences in resting CVCi or cognition (
Table 2
). After adjustment for age and sex, lower cerebrovascular reactivity was associated with lower peak oxygen uptake, diabetes, and smoking history (
Table 3
).

Conclusions:
Compared with healthy controls, we report that patients with CAD have significantly lower cerebrovascular function, with no differences in cognitive function.
Abstract 14926: Case of Severe Myocarditis Associated With Nivolumab-Relatlimab
Authors: Garcia Quarto Levindo Jose , Sampaio Rodrigues Thalys , Nuriev Rinat , Maysky Michael
Published: December 2023

Introduction:
Immune checkpoint inhibitors (ICIs) are the standard of care for cancer but can cause immune-related adverse events (irAEs). Nivolumab/Relatlimab combination was approved in March 2022 for unresectable or metastatic melanoma. Cardiac toxicity associated with ICIs is rare but can be fatal. Prompt recognition is key.

Description:
We present a case of an 84-year-old with no cardiac history who experienced worsening fatigue a week after Nivolumab/Relatlimab infusion. This was followed by myalgia, double vision, shortness of breath, and chest heaviness. Her symptoms worsened, and she sought medical care. Tests showed elevated high-sensitivity troponin T and total creatine kinase levels of 1100 and 6000, respectively. Her first EKG revealed first degree AV block. Within hours, she developed a complete AV block. Her initial LVEF was 75%. She was diagnosed with “triple M" syndrome (myositis, myocarditis, and myasthenia) and received pulse-dose steroids and IV immunoglobulin. She developed myasthenic crisis with respiratory failure requiring intubation. Repeat echocardiogram revealed a drop in LVEF to 43% with new regional wall motion abnormalities attributed to worsening myocarditis. Considering fast progression and poor prognosis, the patient and her family chose comfort measures over escalation of care.

Discussion:
Myocarditis is a known but rare irAE with reported incidence of less than 1%. It can be associated with myositis and/or myasthenia. Clinical presentation varies, but rapidly progressive conduction disease is one of the most commonly described conditions. Direct T-cell cytotoxicity is the proposed mechanism. Cardiac irAEs can fully resolve if treated early. However, mortality remains elevated.

Conclusion:
This is one of the few reported cases of severe myocarditis from Nivolumab/Relatlimab. As the combination is still in phase IV development, more cases may emerge in the future and early recognition is vital.
Abstract 14954: Disaggregating the Burden of Cardiovascular Risk Factors and Disease Among Asian Subpopulations in the United States
Authors: Perera Sudheesha , Zheng ZhaoNian , Wadhera Rishi K
Published: December 2023

Background:
Asian Americans are the fastest growing racial group in the US, and represent a highly heterogeneous population. However, little is known about how the burden of all cardiovascular risk factors and diseases varies among Asian American subgroups on a national scale.

Methods:
We identified all Asian adults in the National Health Interview Survey (NHIS) database from 2013 to 2018, and fit survey-weighted logistic regression models to examine the association between each Asian subgroup (Chinese, Asian Indian, Filipino, Other Asian) and outcomes after adjustment for age and sex. We also evaluated how social determinants (education, insurance status, poverty) contributed to any observed associations. NHIS survey weights were used to generate nationally representative estimates.

Results:
The weighted study population included 12,984,588 Asian adults. After adjustment for age and sex, Filipino, Asian Indian, and Other Asian adults were all significantly more likely to have hypertension, diabetes, hyperlipidemia and obesity than Chinese adults
(Figure).
For cardiovascular diseases, Filipino adults were significantly more likely to have a history of heart attack (2.76% vs 0.51%; adjusted RR 2.73, 95% CI 1.42-5.22), coronary artery disease (5.00% vs. 1.37%; RR 2.16, 95% CI 1.30-3.55), and stroke (2.71% vs. 0.90%; RR 2.41, 95% CI 1.35-4.26) than Chinese adults, while prevalence rates were similar for other groups (Asian Indian, Other Asian). Differences across Asian subgroups were not attenuated after also including social determinants in our models.

Conclusions:
In this national study, the burden of cardiovascular risk factors and diseases varied significantly across Asian subpopulations. These findings highlight the importance of disaggregating Asian adults in national public health surveillance efforts, to inform targeted initiatives that address inequities in cardiovascular health.
Abstract 14959: Impact of Timing of Venoarterial Extracorporeal Membrane Oxygenation Insertion (Before or After Impella) in Patients With Acute Myocardial Infarction With Cardiogenic Shock Using Impella: From J-PVAD Registry
Authors: Nishikawa Ryusuke , watanabe shin , Shiomi Hiroki , Tanaka Munekazu , Yamashita Yugo , Yamamoto Erika , Yamaji Kyohei , Ono Koh ,   J-PVAD Investigators
Published: December 2023

Introduction:
In patients with cardiogenic shock (CS), Impella, one type of percutaneous ventricular assist device with a catheter-type micro-axial heart pump, plus venoarterial extracorporeal membrane oxygenation (ECPELLA) has been reported to have a better short-term prognosis than venoarterial extracorporeal membrane oxygenation (VA-ECMO) alone, although it was associated with more complications. ECPELLA has often been used in current clinical practice instead of VA-ECMO alone. However, in many cases of acute myocardial infarction (AMI) with CS, there is controversy about whether Impella or VA-ECMO should be installed first.

Hypothesis:
What are the factors associated with Impella use first? Does the timing of VA-ECMO insertion affect prognosis and major adverse events (MAEs) such as hemolysis, hemorrhage/hematoma, peripheral ischemia, stroke, and thrombosis? This study aims to clarify the factors of Impella use first and the prognostic impact of the timing of VA-ECMO insertion (before or after Impella).

Methods:
The Japanese registry for Percutaneous Ventricular Assist Device (J-PVAD) has registered all consecutive Japanese patients treated with Impella between February 2020 and December 2021. In the current study, we evaluated 523 patients with AMI with CS and investigated the factors of Impella use before VA-ECMO and the impact of the timing of VA-ECMO insertion on 30 days mortality and MAEs.

Results:
Out of the total number of patients, 155 (30%) received Impella prior to VA-ECMO, while 367 (70%) received Impella following VA-ECMO. The factors of Impella use before VA-ECMO were the absence of out-of-hospital and in-hospital cardiac arrest. The cumulative 30-day incidence of all-cause death was 46.1% in patients with Impella use before VA-ECMO and 53.5% in those with Impella use after VA-ECMO (Log-rank P=0.13). There was no excess risk of Impella use before VA-ECMO relative to Impella use after VA-ECMO (adjusted HR, 0.95; 95%CI, 0.47-1.94; P=0.90). There were no significant differences in the incidence of MAEs between the two groups.

Conclusions:
The prognosis for patients with AMI complicated by CS requiring ECPELLA remained poor, but the timing of VA-ECMO insertion did not affect the prognosis.
Abstract 15039: Procedural and Cardiovascular Outcomes of Intravascular Lithotripsy and Rotational Atherectomy for Calcified Coronary Artery Lesions: A Systematic Review and Meta-Analysis
Authors: Thondup Tenzing T , Upadhyay Jeet , Khanna Shaun , Naz Sabrina , Bhat Aditya
Published: December 2023

Introduction:
Calcified coronary lesions (CCL) are associated with higher peri-procedural complications and long-term morbidity and mortality. Treatment of CCL require preparation prior to stenting, with rotational atherectomy (RA) and intravascular lithotripsy (IVL) frequently utilized for lesion preparation. There are limited comparative studies assessing procedural and cardiovascular endpoints between RA and IVL. This meta-analysis will compare procedural and cardiovascular outcomes in patients undergoing RA versus IVL.

Hypothesis:
We hypothesize that there are no significant differences in major cardiovascular outcomes between RA and IVL, however differences in procedural parameters may be present.

Methodology:
A systematic literature search of medical databases using PRISMA principles identified all relevant studies comparing RA vs IVL in CCL (PROSPERO CRD42023411701). Data for all variables were extracted and those with low heterogeneity were then meta-analyzed using a random-effect model for odds ratios (OR) or standardized mean differences (SMD). Primary outcomes assessed were of major adverse cardiovascular events (MACE) and death, whilst secondary outcomes were procedural parameters and complications.

Results:
170 studies were screened, of which 4 peer-reviewed articles and 3 abstracts fulfilled criteria for inclusion. Abstracts were included to increase power. No significant between group differences were observed in contrast volume, coronary dissections and perforations, slow or no-reflow, in-hospital MACE and cardiovascular (CV) death, as well as follow-up stent thrombosis and primary CV outcomes. Of note, IVL had shorter fluoroscopy times (SMD 0.560; p<0.001) and greater use of intracoronary imaging guidance (OR 0.295; p=0.007).

Conclusion:
No significant differences in major cardiovascular outcomes were found between RA and IVL in treatment of CCL, however differences in procedural parameters were appreciated.
Abstract 15041: Single-Cell RNA Sequencing Reveals Four Distinctive Endothelial Subpopulations Through Mouse Endothelial Aging
Authors: Han Jung-Kyu , Sohn Min-Hwan , Dangwal Seema , Seo Jeong-Sun , Liao Ronglih
Published: December 2023

Introduction:
Endothelial cell (EC) dysfunction is a hallmark of vascular aging, contributing to age-related vascular diseases. Elucidating EC aging at the single cell level has significant scientific and therapeutic potential.

Research Question:
What is the landscape of EC aging at the single cell level?

Methods:
Mouse aortas were harvested from 1-, 10-, and 20 month-old mice (n=2 males and 2 females at each time point). Pooled single-cell suspensions were prepared, and PECAM1+ cells were enriched by magnetic-activated cell sorting.

Results:
Single cell RNA sequencing revealed 879 ECs, categorized into six subpopulations (EC 1-6). Of the three canonical EC markers (
Pecam1
,
Cdh5,
and
Kdr
) EC1 and 2 showed higher expression of
Pecam1
, whereas EC3 and 4 showed higher expression of
Cdh5
and
Kdr
. ECs from young (1 month-old), middle-aged (10 month-old), and elderly mice (20 month-old) were enriched in EC1, EC3, and EC4, respectively. Gene regulatory network analysis identified specific regulons for each EC subcluster. EC1 displayed progenitor-like features (
Isl1
as one of the top regulons,
Procr
and
Cd34
as highly expressed genes) with high angiogenic potential (
Twist1
as one of the top regulons,
Timp2
,
Mmp14
, and
Mmp2
as highly expressed genes) and the longest G1 phase suggesting its quiescence. EC3 cells exhibited high proliferative status demonstrated by G2M or S phase, accompanied by upregulation of stress-responsive TF Atf3 and NF-κB family members. EC4 demonstrated pronounced Pparg regulon activity. Genes directly regulated by Pparg (
Scarb1
and
Cd36
), and genes involved in fatty acid metabolism and atherogenesis (
Tcf15
,
Fabp4
,
Gpihbp1
,
Lpl
, and Meox2) were highly expressed in EC4 and EC3.

Conclusions:
Our analysis identified four distinct EC subpopulations through the aging process of mouse aortic ECs: EC1, Pecam1
h
progenitor-like EC; EC2, Pecam1
h
common EC; EC3, Cdh5
h
Kdr
h
inflammatory atherogenic EC; and EC4, Cdh5
h
Kdr
h
non-inflammatory atherogenic EC.
Abstract 15044: The Relationship of Pericardial Fat With Metabolic Change and Myocardial Remodelling Following Bariatric Surgery
Authors: Ardissino Alessandra Maria , Joy George , Crane James D , Knott Kristopher D , Augusto Joao B , Lau Clement , Bhuva Anish N , Seraphim Andreas , Chowdhary Amrit , Fontana Marianna , Plein Sven , Ramar Sasindran , Rubino Francesco , Kellman Peter , Xue Hui , Pierce Iain , Davies Rhodri H , Moon James C , Cruickshank Kennedy , McGowan Barbara M , Manisty Charlotte
Published: December 2023

Introduction:
Pericardial fat is a cardiometabolic risk factor that can be quantified from routine cardiovascular magnetic resonance (CMR) studies. However the extent to which this is modifiable, and its relationship with cardiometabolic markers remains unclear.

Aims:
Determine the effect of bariatric surgery on pericardial fat and associate with cardiometabolic improvements post-surgery.

Methods:
Thirty-eight people referred for bariatric surgery were assessed pre-operatively using CMR, blood biomarkers and anthropometry. Six months post-operatively, twenty-seven participants underwent paired follow-up assessments. Pericardial fat was quantified manually from routine short axis cine stacks by a single blinded clinical observer. Linear regression was used to assess the association of pericardial fat volume and cardiometabolic parameters, at baseline and changes pre-
vs
post-surgery.

Results:
At baseline, pericardial fat volume was associated with multiple cardiometabolic parameters including weight (r=0.46 p=0.004), fasting insulin (r=-0.46, p=0.007) hepatic fat concentration (Hepafat) (r=0.37 p=0.029) and LV mass (r=0.38, p=0.019). Pericardial fat remained independently associated with waist circumference after adjusting for the above (β=0.68, 95% CI: 1.24,9.23, p=0.012). At 6 months post-bariatric surgery pericardial adipose tissue reduced by an average of 29% (95% CI: -21-36%, p<0.001). This change was associated with improvements in fasting insulin levels even after adjusting for changes in weight, Hepafat and LV mass (β=0.72, 95% CI: 0.15, 0.70, p=0.005).

Conclusion:
Pericardial fat in obesity associates with multiple adverse cardiometabolic parameters, including waist circumference. Bariatric surgery causes a significant reduction in pericardial fat which associates with reduced insulin resistance, providing a potential modifiable mechanism to reduce cardiovascular risk in patients living with obesity.
Abstract 15060: Inhibition of Endoplasmic Reticulum Stress and YAP/TAZ Signaling Protects Endothelial Function in Diabetes
Authors: Zhou Yan , Cheang Wai San
Published: December 2023

Introduction:
Previous studies have demonstrated the role of Hippo pathway with its major effectors, Yes-associated protein (YAP) and transcription activator with PDZ binding motif (TAZ) in atherosclerosis. However, the involvement of YAP/TAZ signaling in diabetes-associated endothelial dysfunction remains unexplored.

Hypothesis:
We hypothesized that activation of YAP/TAZ signaling links with endoplasmic reticulum (ER) stress and contributes to endothelial dysfunction.

Methods:
Male C57BL/6 mice were fed with high-fat diet, 45% kcal% fat for 15 weeks to induce obesity and diabetes. ER stress alleviator 4-phenylbutyric acid was orally administered for 4 weeks at 100 mg/kg/day. Vascular reactivity of mouse aortas was assessed by wire myograph. Human umbilical vein endothelial cells (HUVECs) were cultured with risk factors such as high glucose and ER stress inducer tunicamycin. Western blot and immunofluorescent staining were performed to evaluate the expressions of protein targets.

Results:
YAP/TAZ signaling was activated accomplished with ER stress in aortas from obese diabetic mice and in endothelial cells treated with risk factors. Chronic treatment with 4-phenylbutyric acid ameliorated endothelium-dependent relaxations as well as inhibited ER stress, YAP/TAZ signaling and oxidative stress in aortas. Phosphorylation of YAP at Ser127 was reduced in mouse aortic arch which was downregulated by ER stress alleviator. In HUVECs, ER stress alleviators significantly inhibited YAP/TAZ signaling and increased NO bioavailability but YAP inhibitor did not suppress ER stress.

Conclusions:
ER stress activates YAP/TAZ signaling, resulting in endothelial dysfunction in diabetes. Inhibition of YAP/TAZ is vasoprotective and exhibits therapeutic potential against diabetic vascular complication.
Abstract 15064: Programmed Death-Ligand 1 Attenuates Myocardial Injury Following Myocardial Infarction
Authors: Zhu Yuanjia , Walsh Sabrina K , Venkatesh Akshay , Lee Seung Hyun , Mullis Danielle , Stark Charles J , Tran Nicholas , Ethiraj Sidarth , Lin Luca E , Wu Catherine A , Padilla Lopez Amanda S , Baccouche Basil M , Syed Umayr , Doan Long T , Yajima Shin , Elde Stefan , Wang Hanjay , Park Matthew H , Jackson Christopher , Lim Michael , Woo Y Joe
Published: December 2023

Introduction:
Myocardial infarction (MI) represents a major global cause of morbidity and mortality. Immune therapy to mitigate the secondary injury to myocardial tissues following MI is lacking. Programmed death-1 (PD-1) is an inhibitory protein expressed by immune cells during activation. Programmed death-ligand 1 (PDL1) binds to PD-1 and limits collateral damage in diseases with chronic inflammatory response. The objective of this study was to evaluate the impact of PDL1 on myocardial injury following MI.

Methods:
56 C57BL/6 male and female mice underwent left anterior descending artery (LAD) ligation. Mice were randomized to receive 50 μg of PDL1 (14 intramyocardial, 14 intraperitoneal) or PBS (12 intramyocardial, 16 intraperitoneal) immediately after LAD ligation. Echocardiography was obtained at baseline and 2 weeks after MI. Mice hearts were then explanted and sectioned for Masson’s trichrome staining. An additional 25 mice after MI without treatment were terminated on postoperative day 1, 3, 5, 7, and 14. Peripheral blood and myocardium were stained for CD45, CD11b, Ly6c, and PD-1 for flow cytometry.

Results:
Myocardial infarct size reduction was observed after PDL1 treatment (
Fig. A-C
). Compared with controls, PDL1 delivered intramyocardially significantly improved ejection fraction from 29.8 ± 12.4 % to 41.4 ± 14.0 % (p = 0.04), and when delivered intraperitoneally, from 32.5 ± 9.4 % to 47.7 ± 8.0 % (p < 0.0001,
Fig. D
). In the myocardium, the percentage of monocytes that were PD-1+ surged from 0.2 ± 0.2 % on day 1 to 83.8 ± 17.7 % on day 3 and remained elevated 14 days after MI at 31.5 ± 23.6 % (
Fig. E
).

Conclusions:
PDL1 can attenuate myocardial injury and partially preserve cardiac function following MI in a rodent model. PD-1+ monocytes may be one of the key mediators of secondary myocardial injury after MI. Future studies will determine the mechanism of how PDL1 salvage myocardial damage to help develop a potential novel therapy.
Abstract 15108: Systematic Review to Explore Differential Frequencies of Coronary Artery Disease in Survivors of Different Cancers
Authors: Velusamy Ragani , Soh Cheng Hwee H , Marwick Thomas
Published: December 2023

Introduction:
The leading non-neoplastic cause of morbidity and mortality in cancer survivors is cardiovascular disease, of which coronary artery disease (CAD) is emerging as a significant burden. Inherent in screening is an understanding of pre-test risk, and the association of CAD with particular cancers is not well-defined.

Hypothesis:
To develop a systematic review to explore differential frequencies of CAD in survivors of different cancers.

Methods:
We searched MEDLINE and EMBASE (2006-2021) for studies of CAD in survivors. For studies without a control population, we utilized a community prevalence for CAD from the 2021 US. National Centre of Health Statistics; 0.5% for 18-44 years, 4.7% for 45-64 years, 11% for 65-74 years and 19.5% for >75 years. A random-effects model was used to compare CAD prevalence in survivors and controls.

Results:
Twenty studies (736,956 survivors) involved 17 types of cancer (bladder, breast, colorectal, hematologic, head and neck, kidney, liver, lung, melanoma, ovarian, pancreatic, prostate, renal, stomach, testicular, thyroid, uterus). Survivors overall were associated with an increased risk of CAD compared to controls (risk difference = 0.11, 95% CI: 0.07-0.15, p=0.0, I2=99.93%). Eight cancer types (breast, hematologic, head and neck, kidney, liver, pancreatic, stomach, and testicular) resulted in a significantly higher CAD compared to other cancer types (Figure).

Conclusions:
Cancer survivors are at an increased risk of CAD compared to general population, but certain cancer types associate with a significantly higher CAD risk.
Abstract 15136: Toward the Development of an AI Application to Diagnose Ischemic Heart Disease From a Medical Interview
Authors: Fujita Kosuke , Kanno Honoka , Nakazawa Gaku
Published: December 2023

Background:
Interviewing technique for patients with chest pain depends on each doctor’s skill. Therefore, an artificial intelligence (AI)-based interview system may be useful to stratify probability of ischemic heart disease based on patient’s complaint.

Methods:
As a definitive diagnosis corresponding to the interview is needed as a sample, a medical interview is taken from patients presenting with chest pain as a chief complaint, which is combined with the patient's baseline data to develop an AI algorithm.

Results:
The items used as input attributes in the interview are listed in Table 1. A multilayer perceptron (MLP) was applied to the subjects (N=125) for the prediction of patients diagnosed with angina pectoris (54 cases). These models were validated using the leave-one-out method. Comparisons were made with models in which each of diabetes (45 cases), dyslipidemia (88 cases), hypertension (95 cases) and smoking (never: 60 cases; past: 50 cases; current: 15 cases) were added as attributes in addition to the items in Table 1. (Table 2) The ROC curves of the multilayer perceptron with only the questionnaire items in Table 1 as input attributes and the multilayer perceptron with the dyslipidemia attribute added are shown in Figure 1.

Conclusion:
It was found that the diagnosis of angina pectoris could be detected interview data while the prediction accuracy was improved by adding the attribute of dyslipidemia. Further investigation is needed to complete a highly accurate AI-based application by increasing the number of samples.
Abstract 15140: Cerebral Hemodynamics During Left Ventricular Assist Device Speed Titration
Authors: Favilla Christopher G , Carter Sarah , Atluri Pavan , Gitlevich Rebecca , Genuardi Michael
Published: December 2023

Introduction:
Left ventricular assist device (LVAD) speed may be titrated to optimize cardiopulmonary hemodynamics, but the impact on cerebral blood flow remains poorly understood.

Hypothesis:
Here, we monitored cerebral hemodynamics during ramp studies, to test the hypothesis that LVAD speed correlates with cerebral blood flow and cerebral autoregulation.

Methods:
Patients with HeartMate3 LVADs underwent ramp study for optimization, during which cerebral blood flow velocity (CBFv) was continuously monitored by transcranial Doppler (TCD), and blood pressure was continuously monitored by finger plethysmography. Mx index was used a measure of autoregulation which correlates blood pressure and CBFv (i.e. high Mx index indicates poor autoregulation). The treating cardiologist determined the optimal speed based on cardiopulmonary dynamics (other speeds were categorized as sub-optimal).

Results:
Of 23 patients, 5 did not undergo speed changes. At least two speeds were explored in the remaining 18 patients. When comparing the lowest and highest speeds for each patient, higher speeds resulted in higher CBFv (p=0.02;
Figure 1a
), but no change in autoregulation (p=0.38;
Figure 1b
). However, when comparing the optimal and suboptimal LVAD speeds, CVFv was similar (p=0.89;
Figure 2a
,), whereas the optimal speed was associated with a trend toward favorable autoregulation (p=0.09;
Figure 2b
).

Conclusions:
Cerebral blood flow velocity is sensitive to LVAD speed titration, and cardiopulmonary optimization may improve cerebral autoregulation. A larger cohort and a broader range of speeds may further clarify the impact of speed titration on cerebral hemodynamics.
Abstract 15146: Superior Outcomes of Dual-Arterial Compared With Single-Arterial CABG Are Maintained in Low-Volume Centers in the Veterans Health Administration
Authors: Gikandi Ajami , Dinh Tran , Mi Zhibao , Dematt Ellen , quin JACQUELYN , Haime Miguel , KINLAY SCOTT , Tsao Allison L , Biswas Kousick , Zenati Marco A
Published: December 2023

Introduction:
A 2023 report of the STS Adult Cardiac Surgery Database (ACSD) demonstrated worse clinical outcomes with dual arterial CABG (DAG) compared to single arterial CABG (SAG) at low DAG volume centers (<30 DAG/year). It is unclear how generalizable these results are to low DAG volume centers in the Veterans Health Administration (VHA).

Objective:
We investigated outcomes of DAG with bilateral internal thoracic artery (BITA) or radial artery (RA) plus vein grafts (VG) compared to SAG using a left internal thoracic artery (LITA) graft plus VG in the VHA.

Methods:
This study analyzed data from 25,969 patients undergoing isolated CABG between 2005 and 2015 at 44 VHA hospitals (all performing<30 DAG/year). The primary outcome was 5-year mortality, and the secondary outcome was a composite of major adverse cardiac and cerebrovascular events (MACCE; all deaths, myocardial infarction, stroke, or repeat revascularization).

Results:
1,261 patients (4.9%) received DAG (66.8% LITA plus RA/VG and 33.2% BITA/VG) and 24,708 patients (95.1%) had SAG. Median age and grafts per patient for DAG and SAG were 62 and 63 years and 3.0 and 3.0 grafts, respectively. At 5 years, mortality rates for DAG (10.6% [134 events]) were significantly lower vs. SAG (16.2% [4,011 events]). Similarly, MACCE were lower for DAG (22.0% [278 events]) vs. SAG (28.6% [7,078 events]). Kaplan-Meier analysis for all deaths showed a hazard ratio (HR) of 0.64 (95% CI: 0.54 to 0.76) favoring DAG (Figure). A covariate-adjusted Cox model for DAG vs SAG revealed adjusted HR of 0.70 (95% CI: 0.58 to 0.85) for all-cause mortality and 0.80 (95% CI: 0.70 to 0.91) for MACCE.

Conclusions:
In contrast to a recent STS-ACSD analysis, DAG in the VHA was associated with significantly improved 5-year survival and rates of MACCE compared to SAG. Additional studies are needed to understand the observed lack of negative DAG low-volume/outcome relationship in the VHA.