bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12487: Antiarrhythmic Medication Discontinuation After Ablation of Atrial Fibrillation
Authors: Guo Winston , Slotwiner David J , Reading Turchioe Meghan
Published: April 2024

Introduction:
Antiarrhythmic medications are often needed after atrial fibrillation (AF) ablation but may induce side effects (e.g., nausea, fatigue) or new arrhythmias. Knowing the length of time antiarrhythmics may be needed post-ablation is important for patients evaluating benefits and risks of ablation. The purpose of this study was to evaluate the prevalence of antiarrhythmic discontinuation following AF ablation and analyze associations between demographic variables and discontinuation.

Methods:
We extracted institutional electronic health record (EHR) data for patients who underwent ablation 2010-2019, identified with billing codes. Using medication administration data, we assessed documentation of five common oral antiarrhythmics: amiodarone, flecainide, dronedarone, propafenone, and dofetilide at baseline (within 2 weeks before and after ablation) 2-24 weeks post-ablation, and >24 weeks post-ablation. We calculated standard descriptive statistics and examined differences by age, gender, and race using Chi-square tests.

Results:
Patients (n=1180) had an average age of 64.9 (±12.1) years; 33% were female, and 74% were White. Most (61.2%) had antiarrhythmics documented at baseline; of these patients, 41.8% did not have antiarrhythmics documented at all post-ablation, 21.3% had them documented 2-24 weeks post-ablation but not after, and 19.4% had them documented at both 2-24 and >24 weeks. Documentation of antiarrhythmics beyond 2 weeks post-ablation was more likely among younger patients (<65) versus older (63.3% vs. 54.2%; p=0.017) and trended towards significant for White versus non-White patients (61.4% vs. 54.5%; p=0.07). There was no significant difference by gender.

Conclusion:
More than half of patients had antiarrhythmics documented following AF ablation, especially younger patients.
Abstract 12489: Blood Type A1 Donor and Recipient Matching for Heart Transplant: Does It Matter?
Authors: Kim Seong Kyu , Kobashigawa Jon A , Patel Jignesh , Mersola Savannah , Singer-Englar Tahli , Patel Nikhil , Czer Lawrence , Kittleson Michelle M
Published: April 2024

Introduction:
ABO antibodies bind specific carbohydrate moieties defining the A and B antigens. With blood group A, inter-individual variation in transferase specificity and efficiency results in differential antigen expression and density. These subgroups of A are termed non-A1 and have fewer A antigen epitopes per red blood cell, which is less immunogenic. Our goal was to assess the impact of transplantation of an A1 organ to a non-A1 recipient.

Methods:
We assessed 138 blood-type A heart transplant recipients transplanted between 2013 and 2020. Comparison groups included a "match" group (A1 donor into A1 recipient, and non-A1 donor into non-A1 recipient, n=88) and a "mismatch" group (A1 donor into non-A1 recipient, and non-A1 donor into A1 recipient, n=50). Outcomes included 1-year survival, freedom from cardiac allograft vasculopathy (CAV: stenosis ≥30%), freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, heart failure, percutaneous coronary intervention, defibrillator/pacemaker implant, stroke), and 1-year freedom from any treated rejection (ATR), acute cellular rejection (ACR), and antibody-mediated rejection (AMR).

Results:
The mismatch group exhibited similar subsequent 1-year survival, freedom from CAV, and freedom from NF-MACE and subsequent 1-year freedom from ATR, ACR, and AMR compared to the match group. (Table)

Conclusions:
The mismatch of blood type in A1 and non-A1 between donors and recipients does not adversely affect outcomes after heart transplantation. Selective matching of specific A blood typing for heart transplantation is not necessary.
Abstract 12520: Thirty-Day Readmission Rates and Causes Among Patients Admitted With Acute Myocarditis: Insights From the Nationwide Readmissions Database
Authors: Goyal Amandeep , Lahan Shubham , Dalia Tarun , Ranka Sagar , Acharya Prakash , Pothuru Suveenkrishna , Taduru Siva , Mastoris Ioannis , Sauer Andrew J , Haglund Nicholas , Vidic Andrija , Shah Zubair
Published: April 2024

Introduction:
Myocarditis is a serious inflammatory process that can result in acute and chronic cardiomyopathy. Data on patient characteristics, predictors and national readmission rates related to myocarditis are limited. We sought to evaluate the causes and predictors of 30-day readmission rate of patients admitted with acute myocarditis.

Methods:
Using the Nationwide Readmission Database, we included adult patients (age>18 years old) who were hospitalized between January 2016 to November 2018 for acute myocarditis. Thirty-day readmission rates, causes, and predictors of readmission were assessed.

Results:
We analyzed 9482 patients who were discharged alive with a primary diagnosis of acute myocarditis, without requiring advanced therapies (HTX or LVAD) during the index admission. Within 30 days, 641 (6.8%) were readmitted and half of the readmissions occurred in the first 10 days. The readmitted patients were older (mean age of 50 ± 19 vs 41 ± 17, p =<0.001) and were more females (49 % vs 35%, p= <0.001). Using multivariate logistic regression
(Fig 1A)
, the odds of 30-day readmission was higher in diabetics (OR 1.47: 95% CI 1.05-2.04), smokers (OR 1.39: 95% CI 1.05-1.84), prior MI (OR 2.17: 95% CI 1.36-3.44), chronic lung disease (OR 1.55: 95% CI 1.16-2.07) and renal failure (OR 1.97: 95% CI 1.31-2.96). Recurrent myocarditis (15%), and heart failure (15%) were the most common causes of readmission
(Fig 1B)
.

Conclusions:
The readmission rate among acute myocarditis patients is high and is driven by recurrent myocarditis and heart failure. Early identification of patients at increased risk for readmission may help develop prevention strategies and improve outcomes in acute myocarditis.
Abstract 12524: Very Long-term Mortality After St Elevation Myocardial Infarction (stemi) Complicated By Cardiogenic Shock
Authors: Kanhouche Gabriel , Nicolau Jose , Falcão Dalçoquio Talia , Marchi Mauricio Felippi de Sa , Giraldez Roberto R , Furtado Remo , Baracioli Luciano , Kalil Filho Roberto , de Brito Junior Fabio , Abizaid Alexandre , Ribeiro Henrique
Published: April 2024

Introduction:
About 5-10% of myocardial infarctions develop severe form of presentation, with cardiogenic shock (CS). Despite evidence showing higher in-hospital and short-term mortality in patients with STEMI complicated by CS, long-term follow-up data is lacking.

Hypothesis:
The aim of this study was to assess very long-term prognosis of survived patients with STEMI complicated by CS.

Methods:
STEMI patients (n=1,444) were included (1998-2017) and followed for up to 17.6 years (median 5.4 [2.5-9.9] years). Long-term survival was assessed by Log-Rank test.

Results:
Compared to STEMI without CS, patients who presented CS (n=118) had no significant differences regarding age (62.0 ± 11.8
vs.
60.7 ± 12.7; p=0.31) and female sex (28.0% vs. 25.1%, p=0.51), but had lower left ventricle ejection fraction (38.8±13.0% vs. 49.7±13.1%, p<0.001) and higher mean baseline creatinine levels (1.4±0.6mg/dL vs. 1.2±0.7mg/dL, p=0.002). Of note, CS patients presented higher in-hospital mortality (42.2%) compared to those without CS (OR=28.5; 18.1-44.7, p<0.001). Long-term survival was lower in patients with CS (10.7±0.6 vs. 13.3±0.2 years, log rank =0.016). By multivariate analysis adjusted for baseline characteristics the main factors predicting mortality were age (HR=1.06; CI95% 1.05-1.07, p<0.001), previous MI (HR=1.34;CI% 1.06-1.69, p=0.01), history of heart failure (HR=1.65; CI95% 1.15-2.37, p=0.007), stroke (HR=1.67; CI95% 1.12-2.47, p=0.01), diabetes (HR=1.41; CI95% 1.14-1.74, p=0.001) and the presence of CS (HR=3.65; CI95% 2.92-4.56, p<0.001).

Conclusions:
In a very long-term follow-up after a STEMI, CS increased ~4-fold the mortality rates. After hospital discharge, CS remains an important independent risk factor for death in the follow-up. Our findings reinforce the importance of intensive clinical monitoring with optimal medical and non-pharmacological therapy for the remarkable risk factors in the very long-term post-STEMI complicated by CS.
Abstract 12528: Intima Thickening, Adenosine Reduction and Calcification in CD73-Deficient Mice
Authors: Gao Song , Mills Tingting , Shelat Harnath S , Geng Yong-jian
Published: April 2024

Introduction and Hypothesis:
The 5' exonucleotidase, CD73, is a key enzyme for extracellular adenosine production. Mutations of the CD73 gene
NT5E
have been recently reported to cause a rare arterial disease named Arterial Calcification due to Deficiency of CD73 (ACDC). Using a murine model of ACDC, we tested the hypothesis that CD73 protects the arterial wall from hyperplasia and inhibits calcification of vascular smooth muscle cells (SMC).

Methods and Results:
Echocardiography showed that CD73 deficient mice (
CD73
-/-
, n=11) (1.5 yr old, both sexes) had significantly increased aortic intima thickness than C57BL/6J wild type mice (WT, n=8). In culture with inorganic phosphate (Pi, 3.6mM) for 9 days
CD73
-/-
aortic SMC exhibited elevation of intracellular calcium contents than WT cells (Fig. 1a). HPLC analysis revealed more than 50% reduction of extracellular adenosine in
CD73
-/-
SMC compared to that in WT SMC (Fig. 1b). Addition of recombinant apolipoprotein-J (Apo-J, 6μg/mL) diminished Pi-induced calcification and restored extracellular adenosine levels in both

CD73
-/-
-

and WT SMC.

Conclusions:
CD73 plays a key role in maintaining arterial intimal normality, adenosine production and de-calcification. Apo-J serves a regulator of vascular adenosine production and calcification in
CD73
-/-
mice.
Abstract 12561: Dietary and Lifestyle Behaviors Among Women of Reproductive Age by Disability Status
Authors: Litvak Jacqueline , Stein Cheryl R , Deierlein Andrea L
Published: April 2024

Introduction:
In the United States (U.S.), 18% of women age 18-44 years report at least one physical, sensory, or cognitive disability. Compared to the general population, women with disabilities are more likely to have multiple comorbidities and experience adverse pregnancy outcomes. Diet and physical activity are important and modifiable lifestyle behaviors for women’s preconception and long-term health, as well as the health of their offspring. This study examined diet quality, physical activity, and related lifestyle factors among women of reproductive age by disability status and disability type.

Hypothesis:
Diet quality, physical activity, and other lifestyle factors will differ across disability status.

Methods:
Data were from the U.S. National Health and Nutrition Examination Survey 2013-2018 (n=3,409). Disability status was determined by the Washington Group on Disability Statistics questions regarding difficulty hearing, seeing, concentrating, walking, dressing, or running errands alone. Diet quality was evaluated using the Healthy Eating Index (HEI) 2015, with higher scores indicating better diet quality. Self-reported physical activity, food security, and fast food and ready-to-eat food consumption were also assessed. Chi-square tests and generalized linear regression evaluated differences across disability status and disability type.

Results:
Compared to women with no disabilities, women with any self-reported disabilities had lower HEI-2015 scores (46.8 and 50.5, respectively; p<0.05), were more likely to report low/very low food security (48% and 18%, respectively; p<0.05), and were less likely to report meeting physical activity recommendations of ≥150 minutes/week of moderate/vigorous activities (27% and 43%, respectively; p<0.05). Differences were also observed by disability type, such that women with self-reported vision difficulty consume more fast food meals in one week compared to women with no disabilities.

Conclusions:
Women of reproductive age with disabilities report lower diet quality, food security, and physical activity. Future research should focus on identifying and improving modifiable lifestyle behaviors among this population to reduce disparities in maternal and child health outcomes.
Abstract 12566: Aortic Smooth Muscle Cell Focal Adhesion Kinase (FAK) Activation is Prominently Associated With Acute Aortic Dissections in Patients and Mouse Models and Loss of FAK Signaling Augments Dissections in Mice
Authors: Zhou Zhen , Li Yanming , Zhang Chen , Vasquez Hernan G , Kawamura Yuki , Vaisar Tomas , Dichek David A , Saeys Yvan , Daugherty Alan , Humphrey Jay D , Shen Ying H , Lemaire Scott A , Milewicz Dianna M
Published: April 2024

Introduction:
Genetic variants predisposing to thoracic aortic disease disrupt proteins either in the extracellular matrix (ECM) or the smooth muscle cell (SMC) contractile unit, and focal adhesions (FAs) are molecular bridges between these aortic wall components. We sought to identify molecular triggers for acute aortic dissection (AAD) in a mouse model with AAD induced by β-aminopropionitrile (BAPN) and patients with type A AAD.

Methods:
At postnatal day 21 (P21), C57BL/6J mice were exposed to BAPN in drinking water (0.5%) and proximal aortas were harvested for single-cell RNA sequencing (scRNA-seq), proteomics assays and transmission electron microscopic (TEM) analysis at P35. Ascending aortic scRNA-seq assays were performed on AAD patients (n=3) and age-matched, cardiac transplantation donors (n=3).

Results:
In the BAPN mice, ruptured AAD-deaths started at P36, and 54% of mice died by P49, despite a significant decrease of BP (111/79 to 95/66 mmHg, p<0.0001). ScRNA-seq and KEGG pathway analysis identified increased FA signaling as the top altered pathway in the BAPN-treated SMC clusters. Similarly, FA signaling was identified as a top upregulated pathway in SMCs from patients’ aortas. Western blots confirmed increased level of FAK phosphorylation in BAPN-treated aortas. Proteomics analysis revealed a FAK-interacting protein, cortactin, and apoptotic proteins, annexin A1, A3 and A5 (p<0.01), as the top proteins increased with BAPN treatment, which was consistent with increased TUNEL signal in BAPN-treated aortas (p<0.01). TEM analysis identified collagen deposition between SMCs and elastic fibers and loss of elastic extensions in BAPN-treated aortic media. Importantly, administration of a FAK inhibitor, PF-573228, starting at P30 in BAPN-treated mice significantly increased AAD-deaths (starting at P35 and all mice died by P48) when compared to BAPN-only treated mice (p<0.0001).

Conclusions:
FA signaling is the major pathway activated in SMCs in mouse pre-dissection aortas and human dissected aortas, thus implicating disruption of SMC-ECM interactions in AADs. Disruption of FAK signaling augments AADs, suggesting that maintenance of FA signaling delays AADs in the ECM-compromised, BAPN-treated aortas.
Abstract 12587: In Postmenopausal Women With Cardiovascular Disease Hypomagnesaemia May Exacerbate Dyslipidemia and Inflammatoty Syndrome
Authors: Gutiu Ioan A , Gutiu Anton I
Published: April 2024

Introduction:
We proposed to study the relationships between the serum magnesium level (Mg) and the presence of atherosclerosis risk factors and inflammatory syndrome (C reactive protein -CRP-, serum fibrinogen, dental state appreciated by missing teeth, -MT- as consequence of periodontosis and/or periodontitis, etc.) in postmenopausal women with cardiovascular disease (CVD).

Methods:
We studied 675 postmenopausal women: mean age 63.7±9.5 years, mean interval from menopause beginning – 9.3 years. Cardiovascular disease was presented such as: old myocardial infarction (34%), angina pectoris (31%), peripheral arterial disease (5%), ischemic cardiomyopathy (5%), stroke (10%), atrial fibrillation (15%). Mean serum cholesterol was 221±52 mg%, smoking index 106±226, systolic arterial pressure 159±25 mmHg, mean MT 16±10, high CRP level in 35.4%, Fibrinogen 418 ±105 mg%, serum magnesium 2.10±0.30 mg%.

Results:
The comparison of the women with normal (565 patients) or reduced levels of serum (Mg<1.8mg%-110 patients), shown: age 61±8 years in normal Mg group, versus 63.7±9 years in reduced Mg group (P< 0.004); BMI 29.7+/-14.1 versus 26.8+/-5.8 Kg/m2 (P<0.03); Triglicerides: 149.7+/-105.1 versus 175.7+/-151.4 mg (P<0.025); serum Glucose 104.7+/-32.3 versus 133.4+/-61.49 mg (P<0.001); HDL-Cholesterol 49.9+/-14.0 versus 42.6+/-11.9 mg (P<0.001); LDL-Cholesterol: 141.8+/-45.1 versus 159.3+/-58.2 (P<001). Concerning inflammation: high CRP level in 26%, versus 44% ,(P<0.002); Fibrinogen 408.2+/-103.4 versus 460.9+/-111.5 mg% (P<0.001); MT 15.03+/-9.01 versus 17.46+/-9.47 (P<0.009).

Conclusions:
Hypomagnesiaemia may intervene in CVD mainly by alteration of membrane ions exchange, endothelium functionality, insulin resistance, inflammation mechanism. In menopausal women, Mg deficit may be important and is found in women more aged, with more low BMI, with dyslipidemia and with the presence of some inflammatory markers: CRP, Fibrinogen, MT. The explanations and consequences of these findings will be discussed.
Abstract 12593: A Disordered Linker Regulates the Dynamics and Activity of the Protease Domain of the Urokinase-Type Plasminogen Activator
Authors: Torres Paris Constanza , Komives Elizabeth A
Published: April 2024

Introduction:
The urokinase-type Plasminogen Activator (uPA) catalyzes the rate-limiting step in the fibrinolysis pathway. How the activity of uPA is regulated is not well characterized and its understanding could unravel alternative ways of tuning fibrinolysis. The uPA has three domains: an EGF-like and a Kringle domain linked through a disordered linker to a serine protease domain. The linker binds to the protease domain through a disulfide bond that is located 22.7 Å away from the catalytic triad. There is no crystal structure available for full-length uPA and it is unknown if these domains interact among themselves. We recently showed that full-length uPA is more active than the protease domain by itself. Hydrogen Deuterium Exchange Mass Spectrometry (HDXMS) revealed that the protease domain was less dynamic in the presence of the EGF and Kringle domains, however, our data did not show any interface between the domains. We hypothesize that the linker is allosterically regulating the protease domain.

Methods:
We mutated two residues in the linker of full-length uPA (S138D and P141A) and measured their activity using a small substrate analog and the endogenous substrate Plasminogen. In addition, changes in dynamics of the protease domain were evaluated using HDXMS.

Results:
The S138D mutation decreased the activity of the enzyme towards both substrates, while the P141A mutation increased the activity towards the small chromogenic substrate and did not alter the activity towards Plasminogen. HDXMS revealed how the dynamics of different loops in the protease domain were affected by the mutations. The 220s loop was less dynamic in the P141A mutant, however the 110s loop, the activation loop and the β9 strand were more dynamic on this mutant compared to the wildtype. The 110s, 170s and 140s loops together with the activation loop and the β9 strand were more dynamic in the S138D mutant. Interestingly, all these loops are between 20 to 40 Å away from the cysteine that connects the linker to the protease domain, as measured from PDB: 1C5W.

Conclusions:
Our results support the hypothesis that the long-range dynamic allostery in full-length uPA is mediated by the disordered linker. In addition, this allostery regulates the activity and dynamics of the protease domain of uPA.
Abstract 12598: Association Between Insurance Type, Clinical Characteristics, and Healthcare Use in Adults With Congenital Heart Disease
Authors: Shalen Evan F , McGrath Lidija B , Ramsey Katrina , Khan Abigail
Published: April 2024

Introduction:
Adults with congenital heart disease (CHD) represent a heterogeneous and growing population with high healthcare utilization. We sought to understand the association between insurance type, healthcare use, and outcomes among adults with CHD in Oregon.

Methods:
The Oregon All Payers All Claims database from 2010-2017 was queried for adults aged 18-65 in 2014 with ICD-9 or 10 codes consistent with CHD; patient demographics, comorbidities, healthcare use, and disease severity were identified. Insurance type was categorized as either public (Medicare and Medicaid) or private (commercial or self-pay). Descriptive statistics were used to compare groups. Use rates and odds ratios were calculated representing probability of at least one event per person-year using logistic regression with clustering on patients.

Results:
Of 12,978 adults with CHD, 53% were privately insured. More publicly insured patients had moderate-severe anatomic complexity (29.5% vs 22.9%; p < 0.0001), drug and alcohol use (22.4% vs 4.9%; p < 0.0001), and mental health diagnoses (66.6% vs 50.7%; p < 0.0001). They were more likely to reside in a rural area (24.7% vs 16.0%; p < 0.0001), and less likely to be within an hour of an adult congenital heart disease center (46.7% vs 57%; p < 0.0001). Adjusted for age and CHD diagnosis, publicly insured patients were more likely to use ambulatory (aOR 1.71; 99% CI 1.60, 1.83), emergency (aOR 3.44; 99% CI 3.22, 3.69), and inpatient (aOR 2.63; 99% CI 2.42, 2.85) care (
Table
). Differences in use were more pronounced among patients with higher anatomic complexity.

Conclusions:
Our study shows that publicly insured adults with CHD in Oregon have more anatomically complex disease, more comorbidities, and higher healthcare use despite controlling for CHD diagnosis. Adults with CHD with public insurance represent a population that may benefit from targeted interventions addressing social determinants of health to improve outcomes and decrease healthcare use.
Abstract 12604: Prescribing Patterns of Cardioprotective Antihyperglycemics Among Medicare Beneficiaries Across United States Counties by their Socioeconomic Disadvantageousness
Authors: Hanna Jonathan , Aghajaninargesi Arash , Sangha Veer , Lin Zhenqiu , Krumholz Harlan M , Khera Rohan
Published: April 2024

Background:
Cardioprotective agents, SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP1RA), improve the outcomes of patients with diabetes, but their cost may lead to inequitable use. We evaluated whether the use of these agents is lower in US counties with larger populations of socioeconomically disadvantaged groups.

Methods:
For 2018, we merged national prescription data for Medicare Part D prescribers with county-level demographic measures from the AHRQ. We compared the number of beneficiaries receiving cardioprotective antihyperglycemics to those on metformin across US counties (Figure A/B). By county we determined demographics (median age, sex and race), median income, urbanization, and markers of health status, including prevalence of diabetes, obesity, and smoking. In multivariable linear regression with SGLT2i/metformin and GLP1RA/metformin prescriptions as outcomes, we evaluated county factors associated with use of cardioprotective agents.

Results:
There were 2,983 counties with ≥10 prescribers of metformin. Counties had a median of 155 SGLT2i, 108 GLP1RA, and 2307 metformin-receiving beneficiaries per 100,000 population. There was a large variation in county-level SGLT2i and GLP1RA prescribing relative to number of metformin users (Fig A/B). In analyses that accounted for the sociodemographic characteristics of counties and the prevalence of cardiovascular risk factors, higher % black population, higher median age, higher median income, and urbanization were associated with lower use at the county level of people on SGLT2i and GLP1RA in contrast to metformin (p<0.05) (Fig C/D).

Conclusion:
There was marked variation by county in the use of new, cardioprotective agents. Urban counties and those with large black populations had fewer beneficiaries receiving cardioprotective antihyperglycemic agents.
Abstract 12610: Larger Papillary Muscles and Thicker Chords Were Associated With Post-Operative Left Atrioventricular Valve Regurgitation in Partial AVSD, a Quantitative Three-Dimensional Echocardiography Study
Authors: YOUSSEF DAVID , Khoo Nee Scze , NAMUYONGA JUDITH , Lin Lily
Published: April 2024

Background:
Up to 15% of patients with partial Atrioventricular Septal Defects (
p
AVSD) require re-repair of the Left AtrioVentricular Valve (LAVV), with 30% having significant regurgitation. Previous qualitative studies suggest abnormalities in papillary muscles, shortened chordae and thick chords as features associated with LAVVR. We aim to quantitatively assess the sub valvar apparatus in pAVSD using three-Dimensional Echocardiography (3DE) for its association with LAVVR.

Hypothesis:
We hypothesize that larger papillary muscle and chordal thickness in patients with
p
AVSD is associated with post-operative LAVVR.

Methods:
This is a prospective study between 2006 and 2018, of pAVSD aged 0-18 years. All underwent 3DE under sedation using X7-2 probe on a Philips iE33 ultrasound system. Utilizing offline QLAB multi-planar reconstruction (v.10.8.5) we measured anterolateral (APM) and posteromedial papillary (PPM) muscle length; cross sectional area and circumference; chordal length and thickness in mid systole. We measured post-operative vena contracta and LAVV diameter in Apical 4 chamber using 2D color Doppler. Cohort was divided into patients with significant post-operative LAVVR vs. controls based on LAVV vena contracta/LAVV annulus ratio cut off >0.25 (greatest one-third of cohort), LAVVR (n=22) and Controls (n=44). All variables are indexed to Body Surface Area, expressed as median [interquartile range] or mean (standard deviation).

Results:
LAVVR group were younger at initial surgery, had larger papillary muscles and thicker chords. Table 1 summarizes the variables for Control and LAVVR. Eighteen patients had LAVV re-repair, 14 (63%) were in LAVVR group and 4 (9%) in Controls. Median follow up was 1.5 years. Median time to re-repair was 1.3 years.

Conclusion:
p
AVSD patients with a greater risk of post-operative LAVVR and subsequently re-repair were younger at first repair and had larger papillary muscles length, circumference and thicker chords.
Abstract 12613: Combinatorial Treatment With Epigenetic Modifiers Reduce Endotoxemia-Induced Inflammation in Human Macrophages and Favors Anti-Inflammatory M2 Plasticity
Authors: Gurusamy Narasimman , SIGAMANI VINOTH , RAJASINGH SHEEJA , Johnson Rajasingh
Published: April 2024

Introduction:
Macrophages are key mediators of the pathogenesis of acute lung injury (ALI). During ALI, lung macrophages shift into the M1 phenotype and induce severe inflammatory responses and lung tissue damage. Recently, we have shown that pan inhibition of DNA methyl transferase (DNMT) and histone deacetylase (HDAC) abrogated the inflammation and protected the mice from endotoxemia-induced ALI.

Hypothesis:
We hypothesize that the treatment with a combination of DNMT1-specific inhibitor, procainamide (PRO) and HDAC6-specific inhibitor, tubastatin A (TBA) attenuates lipopolysaccharide (LPS)-induced inflammation in human macrophages via polarization of macrophages towards anti-inflammatory M2 phenotype.

Methods & Results:
Human macrophage cell line (THP-1) was employed in this study. RNA sequencing analysis has identified a significant reduction in the mRNA expression of a panel of pro-inflammatory genes by PRO+TBA treatment in LPS-induced macrophages, and these results were validated and confirmed by qRT-PCR for the expression of TNFα and IL1β. The expression of pro-inflammatory genes IL1β, TNFα and M1 macrophage marker CD80 was significantly decreased (studied by various analysis) by PRO+TBA treatment at 24 hrs after in LPS challenged macrophages, compared to untreated or treated with either PRO alone or TBA alone (Fig. 1 and 2). On the other hand, the expression of anti-inflammatory gene TSG6 and M2 macrophage marker CD206 were significantly increased by PRO+TBA treatment at 72 hrs after LPS challenged macrophages, compared to untreated or treated with either PRO alone or TBA alone (Fig. 2).

Conclusions:
Our results have clearly demonstrated that the combined PRO+TBA treatment significantly reduced the expression of pro-inflammatory genes and M1 phenotype marker; and increased the expression of anti-inflammatory genes and M2 phenotype marker in human macrophages challenged with LPS.
Abstract 12632: The Effect of Rhythm vs. Rate Control for Atrial Fibrillation in All-Cause Mortality in Patients With Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis
Authors: AlSadawi Mohammed , Grewal Prabjot , Stevens Gregg , Jacob Robin , Cao Kerry , Aslam Faisal , SINGH ABHIJEET
Published: April 2024

Introduction:
This meta-analysis assessed the effect of rhythm control (ablation and/or antiarrhythmic medications) vs rate control for atrial fibrillation in patients with heart failure with preserved ejection fraction.

Hypothesis:
Rhythm control with ablation and/or antiarrhythmic medications for atrial fibrillation management may be associated with improved mortality in patients with heart failure with preserved ejection fraction.

Methods:
We searched the databases for studies reporting the effect of rhythm control vs rate control on mortality in patients with heart failure with preserved ejection fraction including Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL. The search was not restricted to time or publication status. Outcomes included rates of long-term mortality (1 year or longer).

Results:
A total of 1210 studies have resulted from the literature search. A total of 9 studies and 18,011 patients were included; 56.2% men, with a mean age of 71.6 years were included in our systematic review and meta-analysis. Our analysis suggested rhythm control for atrial fibrillation was associated with lower risk all-cause mortality (1 year); (odds ratio 0.73, 95% confidence interval 0.541-0.984; P 0.03). The risk of bias is mild to moderate.

Conclusions:
Our results suggest that rhythm control for atrial fibrillation in patients with heart failure preserved ejection fraction was associated with lower risk all-cause long-term mortality >1 year.
Abstract 12643: Sub-Endocardial Viability Index and Survival in the HF-ACTION Trial
Authors: Stafford Patrick L , Bilchick Kenneth C , Shah Kajal , Ondigi Olivia , Mwansa Hunter , Mwansa Victor , Breathett Khadijah , Johnson Amber E , Kwon Younghoon , Bergin James D , Abuannadi Mohammad , Sodhi Nishtha , Mehta Nishaki , Mazimba Sula
Published: April 2024

Introduction:
Myocardial perfusion relative to left-ventricular workload may be estimated by the sub-endocardial viability index (SVI). This can be calculated myocardial oxygen supply-demand balance, which is the ratio of diastolic to systolic pressure-time indices, i.e. [(DBP - PAWP) x (60sec/heart rate - 0.2sec)] / (SBP x 0.2sec), assuming fixed 0.2sec for systole. Low SVI indicates reduced sub-endocardial perfusion and was hypothesized to associate with negative outcomes in HFrEF patients.

Methods:
HF-ACTION was a randomized trial evaluating the efficacy of aerobic exercise training and usual care versus usual care in chronic HFrEF patients. SVI was calculated in HF-ACTION trial patients with complete hemodynamic data. PAWP was calculated using the Nagueh formula from echocardiographic-derived measurements ([PAWP=1.24*(E/e’) +1.9] with e’ = [(e’lateral + e’septal)/2]). The association of SVI with the combined endpoint of death or hospitalization, as well as all-cause death, was assessed.

Results:
Of 2331 patients in HF-ACTION, 807 had complete data. The mean SVI was 1.59 ± 0.47. The Cox proportional hazards model for the combined endpoint and all-cause death had HR of 0.66 per unit increase in SVI (p<0.00001, 95% CI 0.55-0.79) and 0.67 (p=0.04, 95% CI 0.46-0.98), respectively. Survival during 4 year follow-up was worse below the mean SVI (p=0.0073) (
Figure 1)
. In 26 patients below the critical sub-endocardial ischemia SVI of 0.7, survival was worse (p=0.0013) (
Figure 2)
.

Conclusion:
Reduced SVI, a metric of the adequacy of sub-endocardial perfusion, is associated with negative outcomes in HFrEF patients.

Figure 1.

Figure 2.
Abstract 12663: Impact of Increased Utilization of Expanded Criteria Donors at a High-Volume Heart Transplant Center: A Quasi-Experimental Analysis
Authors: Wayda Brian , Sandhu Alexander T , Henricksen Erik J , Teuteberg Jeffrey J , Khush Kiran K
Published: April 2024

Introduction:
Increased use of expanded criteria donors (ECDs) could alleviate the donor shortage in heart transplantation (HT), but whether ECDs confer acceptable outcomes remains unclear. We utilized a “natural experiment” to assess the impact of ECD utilization on outcomes.

Methods:
We evaluated outcomes before (2011-15; “pre-intervention”) and after (2016-18; “post-intervention”) the adoption of an aggressive ECD utilization strategy at our high-volume HT program. We compared pre- vs. post- intervention changes in outcomes at our program with those occurring concurrently at other programs in the United States. We defined an ECD as a donor with age > 50 years, left ventricular ejection fraction < 50%, and/or coronary artery disease.

Results:
ECD utilization at our program increased from 10.9% of all HTs pre-intervention to 28.0% post-intervention (p < 0.0001), with a concurrent decrease in ECD utilization nationwide (12.5% to 11.7%; p = 0.08). There was no concurrent change at our program in recipient mix by priority status at listing, blood type, demographics, or comorbidities. Our program experienced significant decreases (pre- vs. post- intervention) in median wait times (67 to 42 days; p = 0.05) and the proportions with prolonged (> 10 days) hospitalization (25.0% to 17.1%; p = 0.04) and any MCS or inotrope requirement (79.4% to 70.6%; p = 0.03) prior to transplant. Nationwide, median wait times were unchanged (p = 0.18) and prolonged pre-transplant hospitalization (p = 0.0009) and MCS/inotrope utilization (p < 0.0001) were increasingly common. At our program, there was no significant change in a composite of death or graft failure at 30 days (2.8% to 1.9%; p = 0.32) or 1 year (6.9% to 8.1%; p = 0.21) post-HT. Concurrently, there were modest changes nationwide in this composite outcome at 30 days (4.3% to 3.7%; p = 0.05) and 1 year (9.9% to 8.6%; p = 0.003).

Conclusions:
A “natural experiment” employing increased ECD utilization at a high-volume HT program was associated with decreases in wait times, duration of hospitalization, and MCS or inotrope requirement prior to transplant, with no accompanying change in recipient mix or post-transplant outcomes. Broader ECD utilization is likely a safe and resource-saving strategy to alleviate the donor shortage in HT.
Abstract 12665: BCL6B is a Putative Endothelial-Specific Master Regulator
Authors: Valenzuela Nicole M
Published: April 2024

Introduction:
BCL6B (ZBTB28) is highly enriched transcription factor in endothelial cells. Yet, the function and gene targets of BCL6B in vascular endothelial cells (EC) are almost completely unknown.

Hypothesis:
BCL6B expression is specified in EC by master regulators, and it regulates vascular specific programming.

Methods:
Using bioinformatics approaches we examined the putative mechanisms of BCL6B regulation in quiescent and activated EC. We examined murine and human endothelial expression and ChIP-Seq datasets; and BCL6B ChIP-Seq data [ENCODE]; and knockdown of Ets family transcription factors.

Results:
BCL6B was specifically enriched in EC compared with all other lineages in both mouse and human. Its expression did not differ in HUVEC that were freshly isolated or long-term cultured. The chromatin landscape surrounding the BCL6B gene was distinctively accessible in EC but not in 6 other cell types in Encode (high H3K27Ac, H3K4me1, H3K4me3, low H3K9me3), indicative of an active promoter and strong enhancer. Among EC, BCL6B expression was particularly high in heart and lung and further enriched within a pro-angiogenic subset of EC. In EC, BCL6B expression highly correlated with SOX17, ERG and FLI1 expression. Moreover, Erg, Ets1, Jun and Fos transcription factor binding to the BCL6B gene could be demonstrated in endothelium. Knockdown of Erg/Fli1 in EC resulted in significant reduction in BCL6B expression. BCL6 consensus DNA binding motifs are predicted within a number of endothelial immune response genes, intersecting with ETS, NFκB and STAT targets. BCL6B ChIP-Seq data in HEK293T demonstrated nearly 8,500 non-redundant peaks. BCL6B bound
PROX1
,
LDLR
,
JAM2
,
ETS1
,
MECOM
,
HOXA9/A10
,
SPRY2, CD36, CDH5, VWA8, GATA6 CD59,
as well as endothelial inflammatory genes
CXCL2, IL8, STAT1, CSF1,
and
CCL20
.

Conclusions:
BCL6B is constitutively expressed by EC, and is predicted to bind endothelial specification and inflammatory genes. We postulate that BCL6B is critical for maintenance of vascular homeostasis as well as for tuning of endothelial inflammatory responses.
Abstract 12671: Trend in Incidence and Mortality of Cardiac Amyloidosis Among Patients With Acute Myocardial Infarction
Authors: Uddin Mohammed M , Mir Tanveer , Pervez Eskara , Deneve Daniel , Tahir Hamza , Damughatla Anirudh , Guduguntla Lakshmi , Zafar Saba , Alraies Chadi , Sheikh Mujeeb
Published: April 2024

Background:
Literature regarding recent trends, outcomes of cardiac amyloidosis (CA) in acute myocardial infarction (AMI) are limited.

Objective:
To study coronary interventions, trends in mortality outcomes among patients with AMI and CA.

Methods:
Data from the national readmissions database (NRD) sample that constitutes 49.1% of the stratified sample of all hospitals in the United States, representing more than 95% of the national population were analyzed for hospitalizations visits for CA among AMI. A Linear p-trend was used to assess the trends.

Results:
Out of the total 4,016,407 adult patients (mean age 68.9 ± 13.8 years, 40.4% females) with AMI, 4,252 (0.11%) had CA. CA was significant positive predictor for mortality in AMI patients (OR 1.3, p <0.001). CA patients had higher rates of complications including 375 (8.8%) VTVF, 1,343 (31.6%) AF, 320 (7.9%) conduction block, 335 (8.1%) cardiogenic shock, 1,146 (27%) and 1,536 (36.1%) AHFPEF and AHFREF, respectively. CA patients had significantly fewer cardiovascular interventions when compared to non-CA patients. Among the total of 363,668 deaths in AMI, 717 (16.9%) had associated CA. PCI had no association with mortality on coarsened exact matching of baseline characteristics (OR 0.37, p<0.02) among CA patients. Sensitivity analysis of STEMI patients had similar results. The trends for incidence and mortality of CA in AMI remained steady over the study years (linear p-trends 0.3164 and 0.7624, respectively).

Conclusion:
CA is a rare pathology associated with significant complications and mortality. Coronary interventions had no significant mortality benefits. Thus, more research will be needed for the management of high-risk patients.
Keywords:
Acute Myocardial Infarction (AMI), Cardiac Amyloidosis (CA), epidemiology; predictors; mortality; complications; risk factors; readmissions.
Abstract 12692: Extracorporeal Life Support After Cardiac Intervention Provides Reasonable Survival Even in Patients With Malignancies
Authors: Suzuki Yota , Iglesias Nicholas , Mao Rui-Min D , Deanda Abe , Radhakrishnan Ravi
Published: April 2024

Introduction:
With an increasingly aging population, cardiac surgery in oncologic patients is no longer rare. In postoperative cardiopulmonary compromise, the use of extracorporeal life support after cardiac intervention (Post-cardiac ECLS) has increased in general but its efficacy in oncologic patients is not clear.

Hypothesis:
ECLS after cardiac intervention provides reasonable survival in patients with malignancies.

Methods:
The Extracorporeal Life Support Organization registry was queried for patients older than 18 years with an International Classification of Diseases codes of hematologic and solid malignancy over the last decade (2010-2019). Among them, patients who underwent cardiac surgery or transcatheter valve intervention were selected. Outcomes and clinical data including types of procedure and cancer subtypes were analyzed.

Results:
One hundred and sixty-two patients met inclusion criteria: 17 pulmonary ECLS, 119 cardiac ECLS, and 26 extracorporeal cardiopulmonary resuscitation. Sixty-two patients (38.3 %) survived to discharge, which was significantly worse than all adult ECLS runs over the same time period (49.0%). Among subtypes, hematologic (p=0.041) and breast cancer (p=0.023) were associated with worse prognosis in comparison with all adult ECLS runs. Coronary artery bypass grafting (n=56) and surgical valve procedure (n=54) were dominant types of the procedure with a survival of 44.6% and 33.3%, respectively. Ventricular assist device procedure (n=48) and cardiac transplant (n=21) were also commonly performed with a survival of 37.5% and 33.3%, respectively.

Conclusions:
Use of Post-cardiac ECLS in oncologic patients has been increasing. Considering the poor outcomes reported in ECLS for postcardiotomy shock in general, our observed survival rate seems reasonable and should not exclude this population from ECLS consideration, with careful patient selection.
Abstract 12762: Higher Incidence of Heart Failure and Arrhythmias in Atrial Fibrillation Patients Hospitalized With COVID-19
Authors: Pereira Leanne , Zain elabidin Awfa , Namdarizandi Vahid , Sharma Vivek , Fatuyi Michael , Kasan Shalemar Ann , Tappuni Bassman , Kaseer Belal , Brandt Dominique , Shemisa Kamal
Published: April 2024

Introduction:
Atrial fibrillation (Afib) is a common arrhythmia with significant morbidity and mortality. The cardiovascular effect of COVID-19 infection in patients with known Afib is poorly understood. The aim of this study was to analyze the cardiovascular outcomes of patients with a history of Afib who were admitted with COVID-19 infection.

Methods:
A retrospective cohort study of patients hospitalized between January 1 and July 31, 2020 with COVID-19 infection confirmed by polymerase chain reaction (PCR) testing of nasopharynx sample was stratified by history of Afib, and analyzed for patient characteristics and cardiovascular outcomes using Mann-Whitney & χ
2
tests. A p value of <0.05 was used for statistical significance.

Results:
Among the 321 patients admitted with a positive COVID-19 test, 12% (38) had a history of Afib. This subgroup was significantly older, median age 84.5 vs. 61 and were predominantly male, 66 vs. 34%. They showed a higher prevalence of heart failure with reduced ejection fraction (HFrEF) (26 vs. 6%) and with preserved ejection fraction (HFpEF) (34 vs. 13%), CAD (34 vs. 17%), chronic kidney disease (45 vs. 20%), and dyslipidemia (66 vs. 35%) compared to those admitted without a history of Afib. These patients had a wider QRS interval 101 (88-134) vs. 94 (86-104) and more elevated BNP levels 278 (109-696.5) vs. 234 (35-158). They were also more likely to experience Afib (53 vs. 7%) and ventricular arrhythmias (18 vs. 6%) during hospitalization, but they did not show any statistical difference in terms of mortality rate, ICU admission, use of mechanical ventilation, or 30-day hospital readmission.

Conclusion:
Patients admitted with COVID-19 with a history of Afib were older and had comorbid cardiovascular disease. Heart failure risk markers such as wider QRS interval and higher BNP levels were more common in the history of Afib subgroup of patients. These patients had a higher incidence of heart failure and arrhythmias but not mortality.
Abstract 12768: Development of a Clinical 3D Modeling Program to Guide Pediatric Cardiothoracic Surgery and Intervention
Authors: Ghosh Reena M , Jolley Matthew , Mascio Christopher , Chen Jonathan M , Fuller Stephanie M , Rome Jonathan J , Silvestro Elizabeth , Whitehead Kevin K
Published: April 2024

Introduction:
Surgical and catheter-based interventions for congenital heart disease require precise understanding of complex anatomy. The use of three-dimensional (3D) visualization techniques to enhance visuospatial understanding has been well documented, but integration of these methods into routine clinical practice has not been well described. We report the growth and development of a clinical 3D modeling service to inform procedural planning within a high-volume pediatric heart center.

Methods:
Clinical 3D modeling was performed using cardiac magnetic resonance (CMR) or computed tomography (CT) derived data. Image segmentation and post-processing was performed using FDA-approved software. Patient-specific anatomy was visualized using 3D printed models, digital flat screen models and virtual reality. Surgical repair options were digitally designed using proprietary and open-source computer aided design (CAD) based modeling tools.

Results:
From 2018 to 2020 there were 112 individual 3D modeling cases performed, 16 for educational purposes and 96 clinically utilized for procedural planning. Over the 3-year period, demand for clinical modeling tripled and in 2020, 3D modeling was requested in more than one-quarter of STAT category 3, 4 and 5 cases. The most common indications for modeling were complex biventricular repair (n = 30, 31%) and repair of multiple ventricular septal defects (VSD) (n=11, 12%).

Conclusions:
Using a multidisciplinary approach, clinical application of 3D modeling can be seamlessly integrated into pre-procedural care for patients with congenital heart disease. Rapid expansion and increased demand for utilization of these tools within a high-volume center demonstrate the high value conferred on these techniques by surgeons and interventionalists alike.
Abstract 12773: Sources of Health Information and Health-Seeking Patterns of Filipinos in Rural Communities in the Philippines
Authors: Evangelista Lorraine S , Lorenzo Elizabeth
Published: April 2024

Background:
Rural healthcare delivery and access have various obstacles due to limited infrastructure for health promotion, limited health information sources, reliance on medical advice from multiple sources, and a lack of skilled rural healthcare practitioners. The disparity in access to healthcare is ultimately why healthcare in rural communities is inadequate.

Aims:
This cross-sectional study describes sources of health information and health-seeking behaviors (e.g., type of healthcare provider, response to illness) of adults (aged ≥ 18) living in rural, largely underserved communities in the Philippines.

Methods:
Participants completed a survey assessing health information sources and health-seeking habits. Descriptive statistics and χ
2
-tests were used to compare age groups (young vs. old 60]) and sex.

Results:
Surveys were completed by 1203 persons (65% female, age 50 ±18 years). The preferred source of health information was friends and family (57%), followed by social media (28%) and healthcare providers (15%). Participants said they sought healthcare largely from physicians (60%), herbalists (12%), nurses (5%), and quack doctors (5%) or a combination of providers (12%). When they were ill, the majority (70%) visited a healthcare provider, while 48%, 39%, and 30% self-medicate, sought advice from a rural health clinic, or pray, respectively. There were no variations in the sources of information, care provider preferences, or illness response between the sexes. Younger persons were more inclined to seek health information on social media and from a physician. By contrast, older persons were more likely to seek advice from friends and relatives and contact a herbalist or quack physician.

Conclusions:
Our results highlight the need for well-structured programs and campaigns to address the population's demands understandably. Additionally, it emphasizes the importance of enhancing the quality of information available to rural communities and integrating friends and relatives, social media, and healthcare providers to provide evidence-based health information. Finally, more research is required to identify why so many people sought medical advice from friends and family members rather than licensed healthcare professionals.