bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 125: The Association of Racial Residential Segregation and Survival to Discharge After Out-of-Hospital Cardiac Arrest in the United States
Authors: Abbott Ethan , Buckler David , Shekhar Aditya C , Abella Benjamin , Richardson Lynne , Carr Brendan G , zebrowski alexis
Published: December 2023

Introduction:
Racial and economic segregation is associated with poor health outcomes, including out-of-hospital cardiac arrest (OHCA) survival. Prior work identified disparities in OHCA survival for Medicare beneficiaries associated with residential segregation. We sought to use registry data to evaluate this association of racial and economic segregation with OHCA survival to discharge.

Methods:
We conducted a retrospective analysis of the 2013-2021 Cardiac Arrest Registry toEnhance Survival OHCA dataset. Arrests with missing data, pediatric patients, or EMS-witnessed were excluded. Our primary predictor, the index of concentration at the extremes(ICE), is a validated measure of racial and economic segregation. We examined three ICE measures (race, income, and race + income) calculated from US Census data and binned into tract-level quintiles. The primary outcome was survival to discharge. We performed multi-levelPoisson regression, with hospital random effect, and adjusted for age, gender, race and ethnicity, witness status, location, and bystander CPR to predict relative risk of survival to discharge and good neurological outcome.

Results:
We identified 624,626 adult OHCA patients with median age 64 years (SD 17), 38%female, 22% Black/African American, 50% White, 6.8% Hispanic/Latino. Overall, 156,712 (25%)survived to hospital admission, 10% survived to hospital discharge and 6.3% had good neurological outcome. Patients residing in the most segregated White and higher income tracts(Q5) had a 7-10% higher likelihood of survival to discharge compared to the most segregatedBlack and lower income communities (Q1) across all three measures (race RR: 1.09, CI 1.05-1.12; income RR: 1.07, CI 1.04-1.10; race + income RR: 1.10, CI 1.06-1.13). Similarly, neurological recovery was higher in Q5 (race RR: 1.20, CI 1.15-1.25; income RR: 1.12, CI 1.08-1.16; race + income RR: 1.19, CI 1.15-1.23) compared to Q1.

Conclusion:
We identified outcome disparities across three ICE measures for residents of the most segregated and lowest income Black census tracts compared to those in most segregated higher income White census tracts. Future work should focus on interventions for these disparities to improve survival and address health inequities.
Abstract 12600: COVID-19 Hospitalizations With and Without Pulmonary Hypertension: An Analysis of the 2020 Nationwide Inpatient Database
Authors: Evbayekha Endurance O , Jelwan Yara , Gaibor Carlos , Bastidas Leonela , Kuttab Rani , Desai Purav , Markson Favour , Shah Bobby
Published: December 2023

Introduction:
Among individuals with active SARS-CoV-2 (COVID-19) infection, emerging evidence suggests that pulmonary hypertension (pHTN) of any etiology may be associated with poor outcomes. We studied the in-hospital population with pHTN and COVID-19 infection.

Hypothesis:
Studying the impact of COVID-19 on pHTN patients is essential and may inform optimizing patient management and improving outcomes.

Methods:
We derived our sample using the 2020 National Inpatient Sample Database (NIS) discharge data. Our population was patients with a primary admission diagnosis of COVID-19 identified using the ICD 10 code U071. We divided this sample into two groups based on a secondary diagnosis of pHTN or no pHTN. We used multivariate logistic regression analysis to account for confounders and estimate the probability of our outcomes.

Results:
There were 1,058,815 primary hospitalizations for COVID-19, and 2.37% (25,070) had pHTN, with a female predominance of 56.8% and a mean age of 71.3 years ±14.7. By ethnicity, 58.7% were Caucasians, 22.1% were Blacks, and 12.9% were Hispanics. Following multivariate analysis, we found that pHTN was associated with significantly higher odds of pulmonary embolism (PE), adjusted odds ratio (aOR) 2.2 (1.9-2.5, p<0.0001), cardiogenic shock 3.2 (2.4-4-2, p<0.0001), acute respiratory failure 1.7 (1.6-1.8, p<0.0001), Invasive mechanical ventilation, 1.6 (1.5-1.7, p<0.0001), and in-hospital mortality 1.7 (1.6-1.9, p<0.0001).

Conclusion:
Our study showed that pulmonary hypertension was associated with significantly higher odds of acute respiratory failure, invasive mechanical ventilation, pulmonary embolism, cardiac shock, and in-hospital mortality in patients admitted for COVID-19. Particular emphasis on preventive measures cannot be overemphasized in this group.
Abstract 12617: Predictors of Mortality in African Americans Requiring Intra-Aortic Balloon Pump for Cardiogenic Shock Following Acute Myocardial Infarction
Authors: Ravalani Abhimanyu , Memon Rahat A , Ramphul Kamleshun , Dhaliwal Jasninder , Kumar Nomesh , Sombans Shaheen , Lohana Petras , Sakthivel Hemamalini
Published: December 2023

Introduction:
Past studies have linked African Americans(AA) to disparities in care and outcome. We aim to improve the care of AA by evaluating the predictors of mortality in AA requiring an intra-aortic balloon pump(IABP) for cardiogenic shock(CS) following acute myocardial infarction (AMI).

Methods:
Variables influencing mortality among AA adults with CS from AMI using intra-aortic balloon pump (IABP), were studied via the 2016-2020 National Inpatient Sample.

Results:
Our study found 9050 cases of AMI with CS among AA that required IABP and 3100 (34.3%) of them died. Odds of mortality were higher in those ages ≥60(aOR 1.356, p<0.01), using mechanical ventilation (aOR 2.725, p<0.01), with ventricular tachycardia (aOR 1.231, p<0.01), ventricular fibrillation (aOR 2.215, p<0.01), prior stroke (aOR 1.319, p<0.01), Chronic Kidney Disease (aOR 1.387, p<0.01), cirrhosis (aOR 2.581, p<0.01), hypertension (aOR 1.29, p<0.01), peripheral vascular disease (aOR 1.218, p =0.031), acute kidney injury (aOR 1.281, p<0.01), and females (aOR 1.111, p=0.042). Lower odds were reported in those with lipid disorders (aOR 0.713, p<0.01), alcohol abuse (aOR 0.549, p<0.01), depression (aOR 0.676, p<0.01), drug abuse (aOR 0.483, p<0.01), events of supraventricular tachycardia (0.438, p<0.01), atrial fibrillation (aOR 0.88, p=0.042), smoking (aOR 0.727, p<0.01), obesity (aOR 0.843, p=0.011), and weekend admissions (aOR 0.867, p<0.01). Furthermore, Medicaid (aOR 0.705, p<0.01) and Private Insurers (aOR 0.550, p<0.01) showed reduced risk compared to Medicare-covered patients. Urban non-teaching (aOR 0.52, p<0.01) and Urban teaching(aOR 0.526, p<0.01) centers also had reduced mortality rates (vs. Rural hospitals).

Conclusions:
We found several patient and hospital characteristics that can influence the survival of AA using IABP for CS following AMI. Further research to improve the impact of these factors and alleviate their negative roles on survival should be encouraged.
Abstract 12632: Clinical Outcomes Across Groups of Ejection Fraction and Grades of Diastolic Dysfunction
Authors: Levene Jacqueline , Bhonsale Aditya , Kancharla Krishna , Thoma Floyd W , Mulukutla Suresh R , Voigt Andrew , Shalaby Alaa , Estes Nathan A , Jain Sandeep , Saba Samir
Published: December 2023

Introduction:
Previous studies have examined the association of diastolic dysfunction (DD) with cardiovascular (CV) outcomes. Understanding how clinical outcomes for those with a normal ejection fraction (EF) and DD compared to those with reduced EF is important in mitigating CV risk and optimizing management.

Methods:
153,305 patients with echocardiograms performed at our institution between 2009 and 2022 were included in this analysis and divided into 2 cohorts: A) Normal EF patients (n=136,455) who were further stratified by grade of DD; and B) low EF (EF<50%, n=16,850) patients who were further stratified by EF into four groups. Patients were followed for CV hospitalization or death.

Results:
Over a median follow up of 3.42 years, 23,946 (16%) patients died. There were 31,113 (20%), 13,305 (9%), and 1,269 (1%) hospitalizations for any CV diagnosis, heart failure (HF), or cardiac arrest (CA), respectively. After adjustment for age, CAD, HF, DM, hypertension, AF and CKD, the risk of all-cause mortality and of CV or HF hospitalizations increased steadily with increasing grade of DD in patients with normal EF (Table). The same was observed in cohort B with worsening EF, to greater extent than in patients with preserved EF (Table). The risk of hospitalization for CA in patients with grade III DD, however, was comparable to that of patients with an EF <25% (HR=0.97, 95% CI 0.58-1.62, p=0.90) and worse than patients in better EF quartiles (p<0.001). Patients with grade II DD had a CA hospitalization risk comparable to those with EF between 36-40% (HR=1.11, 95% CI 0.79-1.57, p=0.54).

Conclusions:
Although systolic dysfunction is associated with worse overall death and HF hospitalizations than DD, the risk of CA in patients with grade II and III DD is comparable to that of patients with moderate and severe systolic dysfunction, respectively. Future studies are needed to examine the mechanisms of CA in DD, and optimal treatment strategies for these patients.
Abstract 12643: Role of Aortic Valve Replacement in Moderate Native Aortic Stenosis: A 10-year Outcomes Study
Authors: Badwan Osamah , Hariri Essa , Kassab Joseph , Layoun Habib , Skoza Warren , Harb Serge C , Puri Rishi , Reed Grant W , Krishnaswamy Amar , Svensson Lars G , Kapadia Samir R
Published: December 2023

Background:
Patients with moderate aortic stenosis (AS) exhibit high morbidity and mortality. Very limited evidence exists on the role of aortic valve replacement (AVR) in this patient population.

Objectives:
To investigate the benefit of AVR in patients with moderate AS compared to clinical surveillance on long-term survival.

Methods:
In a retrospective cohort study, patients aged ≥ 60 years with native tricuspid moderate AS between 2008-2016 were selected from the Cleveland Clinic echocardiographic database. Patients were classified as receiving AVR or managed with clinical surveillance. Clinical outcomes included all-cause and cardiovascular mortality, assessed by survival analyses and multivariable-adjusted Cox and competing risks regression, respectively.

Results:
We included 1,421 patients (mean age, 75.3 ± 5.4 years and 39.9% females) followed over a median duration of 6 years. Patients in the AVR group had lower risk of all-cause (adjusted HR = 0.51, 95% CI: [0.34, 0.77]; p = 0.001) and cardiovascular mortality (aHR = 0.50, 95% CI: [0.31, 0.80]; p = 0.004) compared to those in the clinical surveillance group irrespective of sex, receipt of other open-heart surgeries, and underlying malignancy.

Conclusions:
In patients with moderate AS, AVR was associated with favorable clinical outcomes and left ventricular remodeling patients.

Figure 1
Incidence of all-cause mortality and cardiovascular mortality in patients with moderate AS in those who underwent AVR and clinical surveillance.

Hazards ratios (HR) represent relative incidence of AVR versus clinical surveillance. HRs for all-cause mortality were calculated using Cox regression and for cardiovascular mortality using competing risks regression, with non-cardiac mortality as competing event. HRs were adjusted for age, sex, body-mass index, comorbidities, medications, and baseline echocardiographic data (AVA, MG, Vmax, and LVEF)
Abstract 12644: FlowTriever Percutaneous Aspiration Thrombectomy: A Promising Approach to Catch a (Throm)Bus In-Transit
Authors: Vo Phuong Uyen , Ayafor Grace , Matriano-Lim Charles
Published: December 2023

Introduction:
Clot-in-transit (CIT) is a life-threatening emergency that occurs in about 25,000 patients annually and is associated with high mortality due to rapid cardiopulmonary collapse. This is a case of right atrial (RA) CIT extending from existing IVC filter in a patient with pulmonary embolism (PE) who underwent successful FlowTriever® catheter-based thrombectomy.

Description of Case:
A 60-year-old male presented with progressively worsening dyspnea on exertion, generalized weakness and fatigue, intermittent chest pain, and right leg pain with immobility for several weeks. He had a history of deep vein thrombosis (DVT), PE in 2008 treated with 18-month of warfarin. IVC filter was placed at that time for unclear indication. His initial labs showed elevated troponin-I of 34 ng/mL and NT pro-BNP of 3542 pg/mL, atrial flutter with 2:1 conduction, incomplete right bundle branch block, and old inferior infarct on ECG. Imaging revealed an extensive bilateral PE with right ventricle (RV) to left ventricle (LV) ratio of 2.3. Transthoracic echocardiogram (TTE) showed global LV dysfunction with ejection fraction of 44%, RV strain, dilated IVC, and an 8.7-cm mobile CIT in IVC extending into RA. Despite being treated with Heparin infusion, patient remained persistently tachycardic and dyspneic. Given his clinical stagnation due to CIT and submassive PE, he underwent an invasive TTE-guided percutaneous IVC and pulmonary arterial thrombectomy using Inari FlowTriever® catheter. Repeated TTE showed complete resolution of atrial thrombus. There was improvement in pulmonary arterial pressure and symptoms immediately post thrombectomy, but atrial flutter persisted. He was eventually discharged the following day with betablocker and life-long duration of anticoagulation. At follow up, he had complete resolution of symptoms and normal sinus rhythm on ECG.

Discussion:
Although surgical embolectomy is considered first-line therapy, percutaneous thrombectomy should be considered early for CIT to prevent of cardiopulmonary deterioration and shorter hospital course. FlowTriever® is the first device not requiring a cardiopulmonary bypass circuit to be FDA cleared for RA CIT, particularly benefiting patients who are poor surgical candidates.
Abstract 12645: Iron Deficiency in Heart Failure - Screening, Detection, and Prevalence Patterns in a New York Public Hospital
Authors: Mangeshkar Shaunak , Pargaonkar Sumant , Flatow Elie , Borkowski Pawel , Varrias Dimitrios , Faillace Robert
Published: December 2023

Introduction:
Iron deficiency (ID) is common in patients with heart failure (HF) and has been increasingly recognized as a poor prognostic factor.

Objective:
The objective of this study was to quantify the prevalence of ID in HF among our patient population, rate of appropriate screening and detection of ID, and rates of IV iron repletion in eligible patients.

Methods:
This is a retrospective analytical study involving all patients admitted to the floor with acute decompensated heart failure. Data pertaining to demographic variables, comorbidities, patients’ heart failure status such as ejection fraction etc. and iron studies and iron repletion status was obtained. The rates of screening for iron deficiency, appropriate detection using established criteria and iron repletion were calculated followed by data analysis.

Results:
Out of total 126 patients, 35 (27.7%) had objective evidence of iron deficiency in heart failure, 48 (38.1%) did not have iron deficiency, while 43 patients (34.1%) did not have iron studies ordered during course of admission. White patients had lower odds of having iron deficiency compared to African Americans (OR = 0.32, p =0.013) but there was no significant correlation with age or gender. In our cohort, only 37% of patients with iron deficiency received appropriate repletion with IV iron. There was no racial or gender related bias in prescribing iron repletion.

Conclusions:
Screening for iron deficiency in patients with heart failure is still not being adequately performed. There is scope for improvement in the repletion rates of intravenous iron in eligible patients.
Abstract 12752: Comparing Informatics Methods to Identify Guideline Directed Therapy From the Electronic Health Record
Authors: Garvin Jennifer H , Mirman Morgan , Blake Patricia , Bryant Eryn , Dodge Linda , Logan Donald , Kim Youngjun , Curtis Elizabeth , Mascarello Anthony , Myers Nadezhda
Published: December 2023

Introduction:
AHA Get with The Guidelines (GWTG) is a proven in-hospital approach to improving patient outcomes. The Heart Failure (HF) quality measures for quadruple therapy includes angiotensin receptor/neprilysin inhibitors, beta blockers, aldosterone receptor antagonists, and sodium-glucose transport inhibitors, device counseling, vaccination status assessment, and follow up. Capturing guideline directed therapy (GDT) retrospectively can be done in several ways including the current process of manual review of electronic records, abstraction, and submission to the HF Registry. A SmartPhrase can contribute to adherence of GDT at discharge more efficiently.

Research Question:
Our research question was, “Can the use of a SmartPhrase improve adherence to AHA HF guidelines?”

Goal:
To prompt clinicians to address GDT to meet the quality metrics endorsed by the AHA by providing a template for documentation of these therapies in the discharge summary or progress note.

Methods:
We compared our adherence to the GWTG-HF quality measures prior to after implementing a standard HF DC Checklist SmartPhrase. We evaluated whether the improvement was associated with the SmartPhrase. A Health Information student undertook a project with her preceptor, a Quality Data Manager to analyze SmartPhrase use by providers.

Results:
We found significant improvement in most GWTG-HF quality measures, including GDT quadruple therapy post-sharing this SmartPhrase. Downstream potential benefits to improved adherence to these HF GDT metrics are improvement in 30-day readmissions. Positive trends in the GWTG-HF quality metrics included an overall improvement from Q1 2022 baseline data for quadruple GDT therapy of 37.2% to Q1 2023 of 80.4%.

Conclusions:
The adoption of the SmartPhrase improved adherence to the quality metrics. Use of the SmartPhrase varied by provider. Providers used the dot phrase as it was given to them by the team or by copying and pasting the phrase. The use of copy and paste made tracking the use of the SmartPhrase difficult to track electronically. We are exploring additional methods to improve efficient documentation including natural language (NLP).
Abstract 12799: Geographic Variation in Cardiac Amyloidosis in U.S. Veterans From 2012 to 2021
Authors: Aggarwal Vinod , Mohanty April , Seltzer Ryan , Ghannam Hamza , Dev Sandesh
Published: December 2023

Background:
Prior studies suggest variability in cardiac amyloidosis (CA) detection across the U.S. with underdiagnosis in some regions.

Research Question:
It is unknown whether geographic variation exists in the occurrence of CA amongst U.S. Veterans in a contemporary cohort.

Method:
This is a retrospective observational cohort study. CA was defined as ≥ 1 heart failure (ICD9/10) and ≥ 1 amyloidosis diagnosis. For geographic mapping the location was the state of the diagnosing Veterans Affairs (VA) facility. The population at risk was patients in each state with ≥1 VA encounter during the year. The outcomes were incidence and prevalence rates of CA at the state and U.S. Census regional level (per 100,000 patients). The data source was the VA Corporate Data Warehouse (MDClone ADAMS platform).

Results:
The incidence and prevalence rates of CA by region are shown in the Table, and by state in the Figure. There was an increase in incidence and prevalence in all regions in 2012 and 2021. In both years, incidence and prevalence were highest in the Northeast and lowest in the South.

Conclusion:
Despite increasing recognition of CA in the VA Health System, there is regional variation in incidence and prevalence in 2012 and 2021. VA facilities in the Midwest, West and especially the South may have differences in CA detection relative to those in the Northeast region. Further research into health system, provider, and patient factors leading to this variation is needed to ensure health equity and quality of care for patients with CA.
Abstract 12805: Risk Factors of Mortality in Patients on Temporary Mechanical Circulatory Support Undergoing Heart Transplant
Authors: Memon Rahat A , Dhaliwal Jasninder S , Ravalani Abhimanyu , Ramphul Kamleshun , Kumar Nomesh , Sombans Shaheen , Ramphul Yogeshwaree , Lohana Petras
Published: December 2023

Introduction:
Recent studies have shown a rise in temporary mechanical circulatory support (MCS) use among patients requiring heart transplants(HT) in the United States. However, there is a lack of data on the potential risk factors for death among HT patients who also used MCS. We, therefore, explored the National Inpatient Sample(NIS) database to investigate further.

Methods:
All procedures for HT in adults via the 2016-2020 NIS were retained for our study. The use of MCS was also identified via procedural codes based on previous studies. We estimated factors that could influence mortality among MCS patients via multivariable regression analysis.

Results:
Our selection criteria yielded 14545 cases of HT between 2016-2020, and an estimated 31.6%(4590) patients used MCS. A higher mortality rate in MCS patients was reported as 10.1% (465 cases out of 4590) did not survive (vs. 3.1% in non-MCS patients, aOR 3.473, 95% CI 2.966-4.066, p<0.01). In the MCS cohort, patients who died were older (mean age 56.13 vs. 53.65 years), with a higher mean Charlson Comorbidity Index (CCI) score ( mean score of 6.03 vs. 4.30, p<0.01). Factors that contributed to an increased odds of death included Weekend admissions (aOR 1.413, 95% CI 1.086-1.839, p=0.10), Hispanics (vs. Whites, aOR 1.926, 95% CI 1.398-2.652, p<0.01), history of peripheral vascular disease (PVD) (aOR 4.426, 95% CI 2.712-7.221, p<0.01), obesity (aOR 1.668, 95% CI 1.238-2.248, p<0.01), age ≥60years (aOR 1.982, 95% CI 1.593-2.466, p<0.01), and patients covered by private insurance forms (vs. Medicare, aOR 1.341, 95% CI 1.067-1.685, p=0.012). Meanwhile, those with lipid disorders (aOR 0.313, 95% CI 0.234-0.418, p<0.01) and a history of stroke (aOR 0.484, 95% CI 0.246-0.954, p=0.036) showed lower mortality risks.

Conclusions:
Patients who used MCS and are now undergoing HT are at a higher risk of death. Weekend admissions, Hispanics, PVD, obesity, age ≥60 years, and private insurance were linked with higher risks in the MCS cohort, while a history of stroke and lipid disorders had lower risks. Thus, physicians must address these risk factors in their choice of care and provide the appropriate steps to reduce mortality.
Abstract 12814: Impact of Obesity on Catheter Ablation of Ventricular Tachycardia in the United States: In-Hospital and 30-day Outcomes
Authors: Ang Qi Xuan , Tan Min Choon , Yeo Yong Hao , Tan Bryan , Rattanawong Pattara , Tan Jian Liang , Lee Justin
Published: December 2023

Background:
Catheter ablation for ventricular tachycardia (VT) has been increasingly performed. While it is estimated that 42% of adults in the United States are obese, the impact of obesity on VT ablation procedures remains unclear.

Objective:
This study aimed to evaluate the procedural outcomes and 30-day readmission among non-obese and obese patients who underwent catheter ablation of VT.

Method:
Using the Nationwide Readmissions Database, our study included patients aged 18 years or older who underwent catheter ablation for VT between 2017 and 2020. The study cohort was stratified into non-obese (BMI < 30kg/m
2
) and obese (BMI ≥ 30kg/m
2
). The in-hospital procedural outcome and 30-day readmission were analyzed between these groups.

Results:
Our study included a total of 835 obese patients (19.7%) and 3393 non-obese patients (80.3%). Obese group had a higher rate of prolonged length of stay (>7 days) (37.6% vs 31.2%, p<0.01) and a higher cost of hospitalization ($39 983 vs $37 015, p<0.01). Overall, there were no significant differences in early mortality (4.5% vs 3.8%, p=0.45). Apart from increased vascular complications in the obese group (1.8% vs 0.9%, p=0.03), there were no significant differences in other procedural complications between both groups. There were no significant differences in 30-day readmission rates between obese and non-obese groups (15.5% vs 14.1%, p=0.38). Additional analysis performed in the obese group revealed a non-significant decreasing trend in early mortality rate post-procedurally (5.4% to 4.8%,
P
trend
= 0.66). On multivariable analysis, heart failure was associated with a higher risk of 30-day readmission in obese patients (OR: 2.00; 95% CI: 1.01-3.99; p=0.05).

Conclusion:
Our study suggests that catheter ablation for VT can be performed relatively safely in obese patients without significant differences in 30-day mortality and readmission outcomes. Patients should not be excluded from VT ablation on the basis of obesity.
Abstract 12829: Short- and Long-Term Outcomes of Takotsubo Syndrome and Acute Coronary Syndrome. A Meta-Analysis
Authors: Chia Jia Ee , Ang Song Peng , Jaiswal Vikash , Chia Tong Hong
Published: December 2023

Introduction:
Takotsubo syndrome (TTS) is a condition characterized by reversible left ventricular dysfunction with typical regional wall motion abnormalities. Although the presentation mimics acute coronary syndrome (ACS), its exact pathophysiology is not known. Despite the transient nature of cardiac dysfunction in TTS, the prognosis remained uncertain, with mortality rates reportedly comparable to that of ACS. The aim of this study was to compare the outcomes between patients with TS and ACS through a meta-analysis.

Methods:
We systematically searched various electronic databases including PubMed, Embase, and Cochrane Library to identify relevant studies. The outcomes were pooled using the Hartung-Knapp-Sidik-Jonkman random effects model, and the results were presented as odds ratio (OR) with their corresponding 95% confidence interval (CI).

Results:
11 studies with 3,455,862 (95,165 TTS and 3,360,697 ACS) patients were included in the final analysis. The risk of in-hospital mortality (OR, 0.61(95%CI: 0.42-0.89), P=0.01), 30-day mortality (OR, 0.62(95%CI: 0.48-0.81), P<0.001) were significantly lower in the TTS group compared to the ACS group. There was no difference in the risk of cardiogenic shock (OR, 0.87(95%CI: 0.54-1.42), P=0.58) between both groups. The risk of long-term all-cause mortality (OR, 1.10(95%CI: 0.61-1.97), P=0.75) was comparable between both groups, with significantly higher non-cardiovascular cause of mortality (OR, 2.40(95%CI: 1.83-3.15), P<0.001) among the TTS group compared to the ACS group.

Conclusions:
This study suggests a favorable short-term prognosis for TTS patients compared to ACS patients, but a comparable risk of long-term mortality. It is noteworthy that TTS patients have a higher risk of non-cardiovascular mortality. Further studies are warranted to explore the factors contributing to the increased risk of non-cardiovascular mortality in TTS patients in order to improve outcomes in this population.
Abstract 12844: Weekend Admission is Associated With Higher Renal Complications in Thoracic Endovascular Aneurysm Repair for Stanford Type B Aortic Dissection
Authors: Li Renxi , Luo Qianyun , Green Derrick L , Huddleston Stephen
Published: December 2023

Introduction:
A weekend effect characterized by worse perioperative outcomes has been demonstrated in some surgery patients admitted on weekends, as opposed to weekdays. This study aims to examine the weekend effect on outcomes after open surgical repair or thoracic endovascular aneurysm repair (TEVAR) in Stanford Type B Aortic Dissection (TBAD).

Methods:
Patients who underwent TBAD repair were identified in the National Inpatient Sample (NIS) from 2015-2020 by ICD10-CM/PCS. Open surgery and TEVAR were examined separately. Patients were stratified into two cohorts based on weekday or weekend admission. Significant preoperative differences were present between cohorts, so multivariable logistic regressions were performed comparing in-hospital perioperative outcomes. Adjusted preoperative variables included sex, age, race, socioeconomic status, comorbidity, hospital characteristics, length of stay (LOS), days from admission to operation, and total hospital charge were compared.

Results:
Among patients who underwent open TBAD repair, 1,321 were admitted on weekdays and 340 on weekends. Among patients who underwent TEVAR after TBAD, there were 2,018 admitted on weekdays and 440 admitted on weekends. There was no difference in open repair outcomes between those admitted on weekdays versus weekends. In the TEVAR cohort, weekend admission has associated with higher acute kidney injury (AKI) (aOR=1.69, 95% CI 1.33-2.15, p<0.01), post-procedural kidney failure (aOR=5.65, 95% CI 1.45-22.06, p=0.01), and transfer to another center (aOR=1.54, 95% CI 1.21-1.96, p<0.01). Also in the TEVAR cohort, weekend admission was associated with longer LOS, longer wait to operation, and higher cost (all p<0.01).

Conclusion:
Weekend admission is an independent risk factor for higher renal complications patients with TBAD who undergo TEVAR. Eliminating delays in treatment associated with the weekend effect may decrease renal complications, decrease LOS, and decrease cost.
Abstract 12850: Ascorbic Acid Promotes Ventricular Myosin Light Chain-2 Protein Expression and Maturation of Human Induced Pluripotent Stem Cells Derived Cardiomyocytes
Authors: Gao Yu , Su liping , Wei Yuhua , Hu Zhenyu , Tao Zhonghao , Kovalik Jean-Paul , Soong Tuck Wah , Zhang Jianyi J , Pu Jun , Ye Lei
Published: December 2023

Introduction:
The potentially unlimited number of cardiomyocyte (CMs) derived from human induced pluripotent stem cells (hiPSCs) facilitates high throughput applications like cell transplantation, disease modelling, and cardiotoxicity testing during drug development. Despite promising progress in these areas, a major disadvantage that limits the use of hiPSC derived CMs (hiPSC-CMs) is their immaturity.

Hypothesis:
Ascorbic acid (AA) can promote ventricular myosin light chain-2 (MLC-2v) expression and maturation of hiPSC-CMs.

Methods:
Three hiPSC lines (PCBC-hiPSC, DP3-hiPSCs, and MLC2v-mEGFP-hiPSC) were differentiated into CMs (PCBC-CMs, DP3-CMs,a nd MLC2v-CMs, respectively) with or without retinoic acid (RA). hiPSC-CMs were either maintained up to day 30 of contraction (D30C), or D60C, or purified using lactate acid and used for experiments. Purified hiPSC-CMs were cultured in basal maturation medium (BMM) or BMM supplemented with AA for 14 days. The AA treated and non-treated hiPSC-CMs were characterized for sarcomeric proteins (MLC2v, TNNI3, and MYH7), ion channel proteins (Kir2.1, Nav1.5, Cav1.2, SERCA2a, and RyR), mitochondrial membrane potential, metabolomics, and action potential. Bobcat339, a selective and potent inhibitor of DNA demethylation, was used to determine whether AA promoted hiPSC-CM maturation through modulating DNA demethylation.

Results:
AA significantly increased MLC2v expression in PCBC-CMs, DP3-CMs, MLC2v-CMs, and RA induced atrial-like PCBC-CMs. AA treatment significantly increased mitochondrial mass, membrane potential, and amino acid and fatty acid metabolism in PCBC-CMs. Patch clamp studies showed that AA treatment induced PCBC-CMs and DP3-CMs adaptation to a ventricular-like phenotype. Bobcat339 inhibited MLC2v protein expression in AA treated PCBC-CMs and DP3-CMs. DNA demethylation inhibition was also associated with reduced TET1 and TET2 protein expressions and reduced accumulation of the oxidative product, 5 hmC, in both PCBC-CMs and DP3-CMs, in the presence of AA.

Conclusions:
Ascorbic acid promoted MLC2v protein expression and maturation of hiPSC-CMs. The effect of AA on hiPSC-CM was attenuated with inhibition of TET1/TET2 mediated DNA demethylation.
Abstract 12852: Process Mapping the Aortic Stenosis Patient Journey
Authors: Myers Gary , Saathoff Kayli , Leesch Aaron , Olson Liz , Luciano Jean , Hemmitt Roseanne , Leesch Tharen , Congdon Michelle
Published: December 2023

Introduction:
In November 2019 the American Heart Association (AHA) launched Target: Aortic Stenosis, an initiative to improve outcomes of aortic stenosis (AS) patients. Utilizing a learning collaborative model with 15 hospitals, the AHA sought to impact the patient journey from diagnosis by echo through definitive treatment. At three years, process mapping was undertaken to outline learnings from the sites.

Goals:
The goals were to determine the steps that an AS patient follows from diagnosis to definitive treatment, identify gaps in process that prevent diagnosed patients from progressing to appropriate treatment, analyze areas that impact timeliness of this process, and identify changes that can improve identification and movement to definitive treatment.

Methods:
Site interviews were conducted utilizing the “Five Whys” approach of determining root cause. Sites analyzed three segments of the patient journey: identification, echo report findings, and multidisciplinary valve team (MDT) meeting occurrence. An ideal process map was created identifying areas that impact the patient journey. A prioritization matrix was created outlining the impact and effort of needed changes.

Results:
Reporting capability in both echo registries and medical records are key to identifying patients but are not commonly available. Previously unreferred patients were identified. Lack of surveillance tools impacts the ability of hospitals to monitor AS patient care. Lack of defined next steps detailed within echo reports prevents patients from receiving appropriate, timely treatment. The MDT meeting is not often recorded in patient records. Surgical patients often do not go through the MDT process. It is difficult for hospitals to impact patients that are initially identified but that do not continue in the system for unknown reasons.

Conclusions:
There are elements of the patient journey that impact the identification and treatment of moderate and severe AS patients. The prioritization matrix demonstrated solutions to improve processes that range from low effort - low impact to high effort - high impact. Hospitals participating in Target: Aortic Stenosis have identified changes to improve identification of AS patients and impact the timeliness of treatment.
Abstract 12875: Echocardiographic Findings Associated With Subsequent Risk of Native Valve Endocarditis
Authors: Quintero Martinez Juan A , Hindy Joya-Rita , Villarraga Hector R , Lahr Brian , Dayer Mark J , Thornhill Martin , OHoro John , Michelena Hector I , Anavekar Nandan S , Sendi Parham , Desimone Daniel C , Baddour Larry M
Published: December 2023

Introduction:
The association of echocardiographic measurements and subsequent risk of left-sided native valve endocarditis (LS-NVE) is undefined.

Aim:
To determine if transthoracic echocardiographic (TTE) measurements are associated with the subsequent development of LS-NVE in patients without recognized cardiac predisposing conditions.

Methods:
Institutional databases were evaluated for adults diagnosed with LS-NVE from 2008 to 2020. Patients with prosthetic valves, cardiovascular implantable electronic devices, intracardiac devices, injection drug use, and recognized predisposing cardiac conditions were excluded. Patients with a TTE performed 6 months to 3 years before developing LS-NVE were included as cases. Controls were patients within the same Mayo Clinic location with a TTE report and were matched in a 1:3 ratio according to age, gender, Charlson Comorbidity Index (CCI), and echocardiography date. Multivariate logistic-regression analyses adjusting significant variables between cohort's were performed. A p-value <0.05 was considered significant.

Results:
There were 148 cases and 431 matched controls. The median age was 63.8 (IQR: 53.6 - 74.6) years, and 329 (56.8%) patients were males. LS-NVE cases had a higher prevalence of diabetes mellitus (46.6% vs. 30.4%) and chronic kidney disease (46.6% vs. 28.1%) when compared with controls (p<0.001 both). The median CCI score was 3 (IQR: 0-6) for cases and 2 (IQR: 0-6) for controls. After performing adjusted analyses, left ventricular outflow tract velocity (p=0.017), left ventricular ejection fraction (p=0.018), and E: e’ ratio (p=0.050) were associated with the development of LS-NVE (
Figure 1)
.

Conclusions:
Echocardiographic measurements were associated with subsequent LS-NVE development in this preliminary investigation. A larger cohort of LS-NVE patients is needed to validate these findings.
Abstract 12878: Inhibition of NK1.1 Signaling Attenuates Pressure Overload-Induced Cardiopulmonary Inflammation, Pulmonary IFN-γ Production, and Heart Failure Progression
Authors: He Xiaochen , Xu Rui , Pan Lihong , Bhattarai Umesh , Liu Xiaoguang , Zeng Heng , Chen Jian-Xiong , Hall Michael E , Chen Yingjie
Published: December 2023

Introduction:
Inflammation contributes to heart failure (HF) development, the progression from left ventricular failure to pulmonary remodeling, and the consequent right ventricular hypertrophy and failure.

Hypothesis:
NK1.1 plays a critical role in Natural killer (NK) and NK T (NKT) cells, but the role of NK1.1 in HF development and progression is unknown.

Methods:
We studied the effects of NK1.1 inhibition on transverse aortic constriction (TAC)-induced cardiopulmonary inflammation, HF development, and HF progression in immunocompetent male mice of C57BL/6J background.

Results:
We found that NK1.1
+
cell-derived interferon gamma
+
(IFN-γ
+
) was significantly increased in pulmonary tissues after HF. In addition, anti-NK1.1 antibodies simultaneously abolished both NK1.1
+
cells, including the NK1.1
+
NK and NK1.1
+
NKT cells in peripheral blood, spleen, and lung tissues, but had no effect on cardiopulmonary structure and function under control conditions. However, inhibition of NK1.1 signaling by anti-NK1.1 antibodies significantly rescued mice from TAC-induced left ventricular inflammation, fibrosis, and failure. Inhibition of NK1.1 signaling also significantly attenuated TAC-induced pulmonary leukocyte infiltration, fibrosis, vessel remodeling, and consequent right ventricular hypertrophy. Moreover, inhibition of NK1.1 signaling significantly reduced TAC-induced pulmonary macrophage and dendritic cell infiltration and activation.

Conclusions:
Our data suggest that inhibition of NK1.1 signaling is effective in attenuating systolic overload-induced cardiac fibrosis, dysfunction, and consequent pulmonary remodeling in immunocompetent mice through modulating the cardiopulmonary inflammatory response.
Abstract 12897: Automated Assessment of Left Ventricular Function in Tetralogy of Fallot - A Machine Learning Approach
Authors: Adhikari Arnav , Vick Giles , Nguyen Minh B , Doan Tam , Rao Mounica Y , Ouyang David , Parthiban Anitha , Wadhwa Lalita
Published: December 2023

Introduction:
Congenital heart disease (CHD) is associated with significant cardiac anatomic and functional variability. This study tests the implementation and validation of a convolutional neural network algorithm (EchoNet-Dynamic) on a pediatric dataset via a transfer learning approach. We compare the echocardiographic systolic function measure, left ventricular ejection fraction (LVEF), with CMR as the gold standard.

Methods:
Patients ages 1-18 (44% female) who underwent a transthoracic echocardiographic evaluation and CMR for repaired Tetralogy of Fallot (TOF) were divided into 2 groups of EF < and >40%. 406 (2D-A4C views) videos with LVEF calculated using Bullet and Simpson method were identified. MRI EF as a ground truth label was compared with predicted EF data. Inference weights were derived from EchoNet-Dynamic and the weights from re-training the model on pediatric data. Correlation statistics were computed. The metrics included mean absolute error (MAE), root mean squared error (RMSE), and coefficient of determination (R2).

Results:
The R2 of actual vs predicted was 0.83 (0.71-0.89) with an MAE of 3.55. The predicted EF vs MRI EF resulted in an R2 of 0.48 and an MAE of 6.39 (Figure 1 a-c). Bland-Altman analysis between actual vs predicted EF estimates LVEF (bias = 1.64%) with 95% limits of agreement of -7.80% to 11.09%. MRI EF vs predicted values, the model estimates LVEF (bias = -3.12%) with 95% limits of agreement of -18.71% to 12.48%. The smaller body surface area and ages correlated with better model performance in both groups.

Conclusions:
EchoNet-Dynamic trained on a pediatric data set can accurately predict EF and this validates the model’s performance on a distinct CHD population. The predicted EF accurately compares with the MRI assessment. EchoNet Dynamic can be employed via a transfer learning method for automated real-time evaluations of cardiac function in CHD patients with compromised ventricular function and complex anatomical phenotypes.
Abstract 12901: ADAR1 RNA Editing in Vascular Smooth Muscle Maintains Vascular Integrity, Regulates Cell State Transition, and is a Novel Mechanism of Coronary Artery Disease Risk
Authors: Weldy Chad S , Li Qin , Guo Hongchao , Galls Drew , Cheng Paul , Monteiro Joao P , Rasanen Markus O , Li Daniel , Palmisano Brian , Sharma Disha , Worssam Matthew , Gu Wenduo , Bhate Amruta , Kundu Ramendra K , Nguyen Trieu , Li Jin Billy , Quertermous Thomas
Published: December 2023

Adenosine-to-inosine (A-to-I) RNA editing is a common RNA modification catalyzed by ADAR (adenosine deaminase acting on RNA) enzymes. ADAR1 serves a crucial function to edit specific immunogenic double stranded RNA (dsRNA) molecules to prevent the dsRNA sensor, MDA5 (
IFIH1
), activating an interferon stimulated gene (ISG) response. Discoveries in human genetics now implicate deficient ADAR1 RNA editing as a causal mechanism in coronary artery disease (CAD). Here, we reveal in human atherosclerosis, smooth muscle cells (SMCs) express immunogenic dsRNA at markedly higher levels compared to all other cell types. We demonstrate that ADAR1 is the master regulator of RNA editing in primary human coronary artery SMC (HCASMC). Loss of RNA editing through
ADAR1
KD in HCASMC causes an ISG response characterized by upregulation of ISG genes (i.e.
ISG15, IFI6, IFIH1
) in addition to genes with known roles in SMC phenotypic transition and CAD risk (i.e.
KLF4
,
TCF21
, and
ZEB2
). ADAR1 and MDA5 regulate SMC phenotypic modulation and calcification
in vitro
and in atherosclerosis prone mice. scRNAseq analysis reveals SMC to have increasing ISG expression as cells transition from mature SMC to a more calcified chondromyocyte phenotype. To further evaluate the role for SMC RNA editing
in vivo
, we generated a conditional SMC specific
Adar1
KD mouse (
Adar1
flox/flox
,

Myh11
CreERT2
, ROSA
tdT/+

,

ApoE
-/-

). At 2 weeks following SMC-
Adar1
KD, we observe 50% mortality, where mice demonstrate a severe phenotype of elastin degradation and disarray, intravascular hemorrhage, and inflammatory cell infiltration in the aortic wall. This effect was not seen with an endothelial cell specific deletion model (
Adar1
flox/flox

, Cx40
CreERT2

). scRNAseq of aortic tissue shows that SMC-
Adar1
KD causes ISG activation throughout the vessel wall, SMCs show loss of mature SMC markers, and there is robust macrophage and T cell infiltration. Through evaluation of ligand-receptor interaction, we show that
Ccl5:Ccr5
is the principal regulator of cell infiltration following SMC-
Adar1
KD. Here we provide key evidence to support the observations from human genetics that the ADAR1-dsRNA-MDA5 axis is a causal mechanism in vascular disease and warrants further investigation.
Abstract 12958: Temporal Association of Systemic Inflammatory Biomarkers With Incidence of Postoperative Atrial Fibrillation After Botulinum Toxin Type A Administration in Epicardial Fat Pads
Authors: Huh Hannah , Podgoreanu Mihai V , Ferguson William G , Shen Jie , Perrault Louis P
Published: December 2023

Background:
A one-time injection of botulinum toxin type A (BoNT/A) in epicardial fat pads was evaluated for post-operative atrial fibrillation (POAF) in patients undergoing open-chest cardiac surgery in the Ph2 NOVA trial. Treatment with 125U BoNT/A numerically reduced the incidence of POAF in the mITT (36.5% vs 46.1%) and CABG populations (28.4% vs 40.0%), with statistical significance observed in the CABG + ≥65 years subgroup (27.5% vs 56.4%;
P
<0.01). No significant reduction was observed in the 250U group vs placebo.

Purpose:
Explore systemic inflammatory biomarker changes after treatment with BoNT/A and the temporal relation to incidence of POAF.

Methods:
This analysis included 308 patients who received 125U BoNT/A (n=103), 250U BoNT/A (n=103), or placebo (n=102). Subgroup analysis was done for CABG (n=198), age ≥65 years (n=185), and CABG + ≥65 years (n=118). Serum samples were collected preoperatively prior to dosing on Day 1, then post-treatment on Days 2-4 to test for IL-6, IL-10, and hsCRP. A 2-sample
t
test was used for mean concentrations and a linear mixed model was used for fold change (FC) from baseline.

Results:
Baseline levels of IL-6, IL-10, and hsCRP were similar between treatment groups. Reduction of IL-6 (45.7 ± 4.4 vs 62.4 ± 5.8 pg/mL,
P
<0.05; 10.8 vs 15.9 FC,
P
<0.01) and IL-10 (1.49 ± 0.13 vs 2.04 ± 0.24 pg/mL,
P
<0.05; 1.96 vs 2.66 FC,
P
<0.01) was most significant on Day 2 in CABG patients treated with 125U vs placebo, which aligns with the highest rate and risk of POAF (Figure 1). Mean hsCRP was most significantly reduced on Day 4 in the 250U group among CABG patients (193 ± 8 vs 227 ± 10 mg/dL,
P
<0.01) followed by 125U vs placebo (196 ± 10 vs 227 ± 10 mg/dL,
P
<0.05); a similar dose-dependent reduction was observed by FC analysis.

Conclusions:
Treatment with 125U BoNT/A in cardiac surgery patients lowered the incidence of POAF vs placebo and reduced postoperative systemic IL-6 and IL-10 on Day 2, most significantly in the CABG population.
Abstract 12965: Prolonged Travel Time to Transplantation Center is Associated With Poor Outcomes Following Heart Transplantation
Authors: Suarez-Pierre Alejandro , Zakrzewski Jack , Anigbogu Chiagoziem , Iguidbashian John , Peters Laura L , Ambardekar Amrut V , Hoffman Jordan R , Reece T B , Cleveland Joseph C , Rove Jessica Y
Published: December 2023

Background:
The influence of home-to-transplantation center travel time as a potential barrier to healthcare accessibility and its impact on clinical outcomes has not been examined following heart transplantation.

Hypothesis:
Prolonged travel time to the transplantation center leads to worse outcomes and access to healthcare.

Aims:
Study the impact of travel time as an exposure variable in the Organ Procurement and Transplantation Network database.

Methods:
This is an observational study of adult heart transplant recipients who received a graft between 2012-2022 in the United States. Patients who underwent multiple organ transplantation, repeat transplantation, or lacked ZIP codes were excluded. Travel time was calculated using the Google Distance Matrix API in the driving mode between the recipient’s residence and the transplantation center at 9:00 am local time. The primary outcome measured was 5-year survival. A multivariable parametric survival model was fitted to minimize confounding bias.

Results:
Among the 25,923 recipients that met the selection criteria, the median travel time was 65 min (interquartile range 28-111). The group breakdown was as follows: <30 min=7,071 recipients, 30-60 min=7,422, 1-2 hours=5,561, >2 hours=5,869, and 95% of recipients lived within a 5-hour radius of their center. White recipients experienced longer median travel times (62 min, p<0.001) compared to Black (36 min) or Hispanic (40 min) recipients. A travel time of 1-2 hours (survival time ratio [STR] 0.867, 95% CI 0.768-0.978, p=0.035) or >2 hours (STR 0.873, 95% CI 0.773-0.985, p=0.026) away from the transplantation center was independently associated with lower long-term survival rates compared to recipients living <30 min away.

Conclusion:
Extended commute times to transplantation centers may negatively impact long-term survival outcomes for heart transplant recipients, suggesting a need for addressing this potential barrier to healthcare accessibility.