bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13203: CD36 Regulates Factor VIII Secretion From Liver Endothelial Cells
Authors: Reventun Paula , Toledano Sanz Pablo , Alcharani Nunzio , Viskadourou Maria ,   The Cohorts for Heart and Aging in Genomic Epidemiology (CHARGE) Hemostasis Working Group, Morrison Alanna C , Sabater-lleal Maria , Wolberg Alisa S , De Vries Paul , Smith Nicholas L , Osburn William , Arvanitis Marios , Lowenstein Charles J
Published: December 2023

Introduction:
Abnormal levels of the coagulation factor VIII (FVIII) are a risk factor for venous thromboembolism (VTE). Genome-wide association studies have identified novel candidate gene associations that may regulate FVIII levels in humans, including CD36.

Hypothesis:
We hypothesized that CD36 regulates FVIII release from endothelial cells.
Methods and

Results:
We identified a subset of human liver endothelial cells (HLEC) expressing FVIII and purified them using a differentially expressed cell surface protein CD32. CD32+ HLEC expressed FVIII, transported FVIII in intracellular vesicles, and secreted FVIII. We stimulated CD36 signaling or silenced CD36 to test the effect of CD36 on FVIII release. Oxidized LDL (oxLDL), a CD36 agonist, increased endothelial release of FVIII. Conversely, silencing CD36 decreased FVIII release. We searched for an intracellular signaling pathway that mediates CD36 stimulation of FVIII secretion and found that oxLDL increased p38 activity and a p38 inhibitor decreased FVIII release.

Conclusions:
Taken together, our data show that CD36 stimulates FVIII release through a p38 dependent pathway in specialized liver endothelial cells. These results validate genetic epidemiology data linking CD36 to FVIII levels in humans and provide new insights into the regulation of FVIII levels.
Abstract 13212: Prevention of Delayed Coronary Obstruction Following Transcatheter Aortic Valve Replacement Using Intravascular Ultrasound and "Modified" Snorkeling Stent Technique
Authors: Ito Nobuyasu , Mizutani Shunsuke , Hato Daichi , Okamoto Masashi , Goda Akiko , Fujimoto Tomoko , Wada Tsutomu , Ichikawa Yoshitaka , Tokuda Takahiro , Yano Masahiro , Yamane Takafumi , Kiyama Ryosuke , Fujita Hiroshi , Yoshida Kazunori , Masuyama Tohru
Published: December 2023

Introduction:
Coronary obstruction (CO) is a potentially fatal complication that can occur after transcatheter aortic valve replacement (TAVR). Here we report a successful management of a TAVR patient at risk of delayed CO using intravascular ultrasound (IVUS) and a "modified" snorkeling stent technique.

Case presentation:
An 88-year-old woman presented with severe symptomatic aortic stenosis. Despite the left coronary artery (LCA) being not low, a Multidetector Computed Tomography scan identified a relatively long leaflet of the left coronary cusp (LCC) and a calcified nodule on the cusp (Figure 1A), indicating a high CO risk. A transfemoral TAVR was conducted using a 26mm Evolut FX (Medtronic, IL, USA) protecting the LCA with a 6-F Judkins left (JL) 4.0 guiding catheter, a 0.014 inch coronary guide wire, and a guide-extension catheter. Upon reaching the point of no recapture, LCA blood flow was maintained, and hemodynamics was stable. However, IVUS revealed the calcified nodule on the LCC was close to the left main (LM) ostium (Figure 1B), indicating a high risk of delayed CO.We continued and completed the prosthesis deployment protecting the LCA. Following the deployment, We introduced another guiding catheter (6-F JL3.5) into the prosthesis and engaged it with the LCA via the prosthesis frame, utilizing a double-guiding catheter technique. Subsequently, we placed a coronary stent from the LM to the prosthesis (Figure 1C). After the TAVR procedure, we verified that a JL3.5 catheter could easily engage the implanted coronary stent (Figure 1F). This "modified" snorkeling stent technique appears feasible and provides easier coronary access compared to the "Chimney" snorkeling stent technique.
Abstract 13244: Real World Evaluation of an Artificial Intelligence Enabled Digital Stethoscope for Detecting Undiagnosed Valvular Heart Disease in Primary Care
Authors: Rancier Moshe A , Israel Igor , Monickam Vimalson , Prince John , Verschoore Ben , Currie Caroline
Published: December 2023

Background:
Clinically significant valvular heart disease (VHD) affects 1 in 10 adults over 65. Cardiac auscultation, the current point of care clinical standard, has shown a 44% sensitivity for detecting VHD, leaving most patients undiagnosed. A deep learning based artificial intelligence (AI) platform that detects cardiac murmurs associated with clinically significant VHD (moderate severity or higher, confirmed by echocardiogram) was used to assess its real-time impact on the point of care.

Hypothesis:
Use of AI during point of care auscultation may lead to higher discovery rates and earlier diagnosis of VHD compared to conventional practice.

Aim:
Evaluate real world performance of AI vs. primary care physician (PCP) auscultation in identifying previously undiagnosed VHD.

Methods:
This blinded, prospective study enrolled 369 patients aged 50 and older without a prior VHD diagnosis or history of murmur from three different primary care clinics. Four-point cardiac auscultation was performed on each patient by (1) PCP with a standard stethoscope, and (2) coordinator with an Eko digital stethoscope to collect phonocardiogram (PCG) data for analysis by the AI. Each patient received an echocardiogram to confirm whether clinically significant VHD was present, and their PCG recordings were reviewed by an outside expert panel to confirm whether audible murmurs were present. PCP and expert panel were blinded to AI and echocardiogram results. Performance metrics were calculated for both PCP auscultation and the AI in detecting audible VHD.

Results:
The AI showed over twofold improvement in sensitivity vs. PCP auscultation for detecting audible VHD (94.1% vs. 41.2%) with limited impact on specificity (84.5% vs. 95.5%). The AI identified 22 patients with moderate-or-greater VHD who were previously undiagnosed, while PCPs identified eight previously undiagnosed patients with VHD.

Conclusion:
When applied in a primary care setting, a digital stethoscope with structural murmur detection AI showed meaningful impact on new discovery of VHD as compared to conventional practice. These results suggest that AI-powered auscultation at the point of care may significantly increase earlier VHD discovery, facilitate appropriate patient care, and improve outcomes.
Abstract 13257: Impact of Epicardial Adipose Tissue and Its Distribution on Cardiac Function in Patients With Diastolic Dysfunction
Authors: Schulz Alexander , Backhaus Soeren J , Lange Torben , Evertz Ruben , Kutty Shelby , Kowallick Johannes , Hasenfuss Gerd P , Schuster Andreas
Published: December 2023

Background:
Epicardial adipose tissue (EAT) was identified as an important risk factor for diastolic dysfunction and affects cardiac structural remodeling. However, within this patient group the impact of increased EAT and its regional distribution on cardiac function is yet unclear.

Methods:
68 patients with exertional dyspnea (NYHA≥II), preserved ejection fraction (EF≥50%) and diastolic dysfunction (E/e’≥10) underwent rest and stress right heart catheterization (RHC), transthoracic echocardiography and cardiac magnetic resonance (CMR). EAT volumes were depicted from CMR short-axis stacks. First, the impact of increased total EAT was analyzed. Second, we investigated the association of ventricular and atrial EAT with impaired strain at rest and during exercise stress of the adjacent chambers in multivariable regression analysis.

Results:
Patients with high EAT had higher HFA-PEFF and H2FPEFF-Scores as well as nt-proBNP levels (p<0.048). Furthermore, they were diagnosed with manifest heart failure with preserved ejection fraction (HFpEF) more frequently (low EAT: 37% vs. high EAT: 64%; p=0.029) and had signs of adverse remodelling indicated by higher T1-times (p<0.001).While both groups had no differences in biventricular volumetry and left ventricular mass (p>0.074), functional analysis in high EAT patients revealed impaired atrial strain at rest and during exercise stress, while ventricular strain was impaired during exercise stress only.The assessment of regional EAT revealed an independent association of higher ventricular and atrial EAT with functional impairment of the adjacent chambers.

Conclusion:
Patients with diastolic dysfunction and increased EAT show more pronounced signs of diastolic functional failure and structural remodeling. Despite similar morphological characteristics, patients with high EAT show significant cardiac functional impairment, in particular of the atria. Our results indicate that regionally increased EAT directly induces atrial functional failure, which represents a distinct pathophysiological feature in HFpEF.
Abstract 13270: Social Deprivation Index and Cardiovascular Disease Risk Among 2.5 Million Patients in the US
Authors: Aryee Ebenezer K , Ndumele Chiadi E , Khan Sadiya S , Crews Deidra , Sang Yingying , Grams Morgan , Ballew Shoshana , Matsushita Kuni , Coresh Josef
Published: December 2023

Background:
Neighborhood-level social determinants of health (SDOH) impact cardiovascular disease (CVD) risk. However, limited data are available from large, multi-ethnic, national samples with CVD risk factors on how place-based SDOH independently relates to CVD risk, and on whether accounting for place-based SDOH attenuates race/ethnicity differences in CVD risk.

Methods:
We studied 2,538,811 patients free of prior CVD in the Optum Labs Data Warehouse (OLDW). Billing addresses were geocoded to derive social deprivation index (SDI, deciles 0 to 10 as a composite measure of poverty, education, employment, home rental & crowding, single-parent households and no car ownership) at the zip code level. SDI was compared by race/ethnicity, as coded in the electronic health record. Multivariable Cox models quantified the adjusted relative hazard of incident CVD (using hospitalization discharge codes) associated with linearly modeled SDI in the overall population and stratified by race/ethnicity. We also assessed race/ethnicity differences in incident CVD risk before and after adjustment for SDI and CVD risk factors.

Results:
Mean age was 52 years, 57% were female, with a range of health insurance (75% commercial, 15% Medicare, 2.5% Medicaid). The highest SDI was seen among Black and Hispanic patients. SDI was associated with increased risk of CVD in all race/ethnicity groups (Table). Race/ethnicity differences in CVD risk were attenuated when adjusted for SDI and CVD risk factors (e.g., HR for HF in Black vs White patients decreased from 1.59 [95% CI: 1.47-1.72] adjusted for age and sex, to 1.29 [95% CI: 1.18-1.40] further adjusted for SDI, to 1.09 [95% CI: 1.00-1.19] adjusted for SDI and risk factors).

Conclusions:
Social deprivation levels are associated with CVD risk independent of traditional risk factors. Accounting for disparities in SDI, which reflect both present and past influences, attenuates differences in CVD risk associated with race and ethnicity.
Abstract 13273: APOLLO-B, a Study of Patisiran in Patients With Transthyretin Cardiac Amyloidosis: Primary Long-Term Results From the Open-Label Extension Period
Authors: Hung Rebecca R , Correia Edileide d , Berk John L , Drachman Brian , Fontana Marianna , Gillmore Julian D , Mesquita Claudio T , Simoes Marcus V , Yureneva Elena , White Matthew T , Sweetser Marianne T , Jay Patrick Y , Vest John , Maurer Mathew S
Published: December 2023

Introduction:
The Phase 3 APOLLO-B study evaluates patisiran in patients (pts) with transthyretin (ATTR) cardiac amyloidosis over a 12-month (M) double-blind (DB) period, followed by an open-label extension (OLE) period when all pts receive patisiran (NCT03997383).

Hypothesis:
Patisiran provides long-term benefit in pts with ATTR cardiac amyloidosis.

Aims:
Describe safety and efficacy of patisiran during the APOLLO-B OLE (18M+).

Methods:
Pts (18-85 yrs) with ATTR cardiac amyloidosis and heart failure history were randomized 1:1 to patisiran or placebo (pbo). Pts completing DB period were eligible to receive patisiran in the OLE for ≤36M. Results summarized based on DB treatment arm. Exploratory assessments include change from study baseline (CFB) in 6-minute walk test (6MWT), KCCQ-OS, NT-proBNP, and troponin I.

Results:
In the DB period, 359 pts (pbo n=178; patisiran n=181) received study drug (median [range] age, 76.0 [41, 85] yrs; male, 89%; wtATTR, 80%; tafamidis at baseline, 25%); 334 (93%) entered the OLE. In patisiran arm, M12 and M18 results, respectively, were similar for each endpoint: 6MWT and KCCQ-OS (mean [SEM] CFB) –8.09 [5.73] vs –9.21 [6.04] meters (m) and 0.60 [1.36] vs 0.22 [1.48]; NT-proBNP and troponin I (geometric mean fold-CFB [95%CI]) 1.10 [1.03, 1.17] vs 1.17 [1.07, 1.27] and 1.11 [1.05, 1.18] vs 1.09 [1.01, 1.17]). In pbo arm, patisiran initiation in OLE was associated with a slower rate of worsening or relative stability across endpoints; CFB at M12 vs M18, respectively: 6MWT, –25.43 [5.61] vs –31.08 [5.45] m; KCCQ-OS, –3.41 [1.33] vs –4.02 [1.49]; NT-proBNP, 1.39 [1.28, 1.51] vs 1.53 [1.38, 1.71]; and troponin I, 1.29 [1.21, 1.38] vs 1.21 [1.13, 1.30]. Patisiran had an acceptable safety profile; no new concerns. OLE analyses are ongoing; updated data to be presented.

Conclusions:
The M18 results provide evidence that beneficial effects observed in DB period on functional capacity, health status, and quality of life were maintained by continued treatment with patisiran during the OLE. Pbo-treated pts initiating patisiran at M12 showed slowed worsening or stabilization in most endpoints at M18. Early treatment initiation is important: pbo-treated pts did not recover functional capacity or health lost prior to initiating OLE patisiran.
Abstract 13282: Parental Allostatic Load Predicts Time to the Onset of Cardiovascular Disease in Offspring
Authors: Muchira James M , Mogos Mulubrhan F , Kimathi Boniface , Piano Mariann R
Published: December 2023

Background:
Allostatic load, a measure of cumulative stress-related physiologic dysregulation, is associated with major cardiovascular disease (CVD) events. However, despite evidence of familial aggregation of CVD risk factors, the impact of parental allostatic load on the onset and timing of CVD in offspring remains unknown.

Hypothesis:
We hypothesize that offspring of parents with lower allostatic load will have longer CVD-free survival time.

Aim:
To examine whether CVD-free survival in offspring is associated with parental allostatic load and potential sex-specific differences.

Methods:
A secondary data analysis of 6,145 offspring-mother-father trios derived from the Framingham Heart Study Original (exam 10) and Offspring Cohorts (exam 1). Allostatic load was defined as an index (0-16) of 8 variables (systolic and diastolic blood pressure, total cholesterol, HDL, LDL, total cholesterol/ HDL ratio, fasting blood glucose and body mass index). Kaplan-Meier plots, and Irwin’s restricted mean and multivariable-adjusted Cox proportional hazards regression models were used to examine sex-specific differences and the association between parental allostatic load and offspring’s CVD-free survival.

Results:
Parents mean age (SD) was 60.8 (8.1) and offspring’s 34.8 (10.5). 22.8% of parents (n=458) and 12.1% (n=412) of offspring had high allostatic load (>8). In a total of 118,132 person-years of follow-up among the offspring, 1060 incident CVD events occurred. The overall CVD incidence rate was 8.9 per 1000 person-years (95% confidence interval [CI] 8.4-9.5) and sons had a higher CVD incident rate than daughters (11.0 vs 7.2, p<0.001). Offspring of mothers with low allostatic load lived 4 more years free of CVD compared to offspring of mothers with high allostatic load. Similarly, offspring of fathers with low allostatic load lived 3 more years free of CVD. The hazard rate of having incident CVD among offspring of mothers and fathers with high (compared to low) allostatic load was 1.58 (1.28-1.95) and 1.39 (95% CI: 1.11-1.75), respectively.

Conclusion:
Parents' allostatic load has a significant impact on the cardiovascular health of their offspring, with those of mothers with high allostatic load being at a higher risk of developing CVD at a younger age.
Abstract 13320: Age-Based Trends in Improvement in Door-to-Balloon Time Over 15 Years
Authors: Ashraf Muddasir , Allaqaband Suhail Q , Bajwa Tanvir , Walczak Sara , Tunink Kirsten , Peterson Michael , Koblosky Christopher , Jan M F
Published: December 2023

Background:
In April 2004, an in-house 24x7 interventional cardiology program was implemented at our center to improve door-to-balloon time (D2BT) in ST-segment elevation myocardial infarction (STEMI). Data on our program published in 2010 showed improved D2BT along with improvement in major adverse cardiovascular events and mortality.

Hypothesis:
We hypothesized that the median D2BT has further improved over time in both elderly and young patients.

Aims:
The primary objective was to evaluate aged-based yearly trends in median D2BT in patients with STEMI since the implementation of the 24x7 program.

Methods:
We collected data on all non-transfer adult patients with STEMI at our center from April 1, 2004, to March 31, 2019. Median two-sample test was used to compare medians.

Results:
A total of 1,889 patients with STEMI (median age [IQR] of 61 [54-71] years, 31% female) were evaluated. Of these, 221 (11.7%) were aged ≥80 years and 1,668 (88.3%) were aged <80 years. Females made up 60% of the elderly group and 27% in the younger group. In the overall cohort, the median D2BT in patients aged >80 years was significantly higher than in the younger group (54 min vs. 49 min, P = 0.004). Temporal trends in the median D2BT are shown in the figure. There was a decreasing trend in median D2BT in both age groups, but D2BT remained longer for the older patients compared with the young for most of the study period. In patients aged <80 years, the median D2BT decreased from 68 minutes in 2004 to 45 minutes in 2019 (P trend < .001), and in patients aged ≥80 years, the median D2BT decreased from 81 minutes in 2004 to 68 minutes in 2019 (P trend = .016).

Conclusion:
Even though the national averages are beaten by our 24x7 program, D2BT remains higher in the elderly cohort. This is likely due to atypical presentation in elderly females, complexity of the decision-making process in the elderly, and frailty of elderly patients on presentation.
Abstract 13322: Administrating the Anti-Apoptosis Inhibitor of Macrophage Antibody Prevents Aortic Aneurysm Progression in Mice
Authors: Fujii Taro , Yamawaki-Ogata Aika , Terazawa Sachie , Narita Yuji , Mutsuga Masato
Published: December 2023

Introduction:
Our previous report has shown that macrophages play vital roles in developing aortic aneurysms (AA). Apoptosis inhibitor of macrophage (AIM) secreted from macrophages is known to induce apoptosis resistance of macrophages and exacerbate chronic inflammation, which leads to arteriosclerosis. However, it is unclear the role of AIM in AA.

Hypothesis:
We hypothesized that administering the anti-AIM antibody could prevent eventual AA progression via inhibiting chronic inflammation and promoting apoptosis of macrophages.

Methods:
The AA was induced in apolipoprotein E deficient mice by subcutaneous angiotensin II (ATII) infusion. Along with ATII infusion, an anti-murine AIM monoclonal antibody or anti-murine IgG antibody was injected intraperitoneally. Mice were divided randomly into two groups: (i) AIM group; weekly anti-AIM antibody injection (n=10), and (ii) IgG group; anti-IgG antibody injection as control (n=14). All animals were euthanized 4 weeks after study initiation.

Results:
There were two deaths in the control group and one in the AIM group. None of the deaths were aorta-related. Compared with the IgG group, the AIM group exhibited reduced AA enlargement (aortic diameter at four weeks: AIM 2.1 vs. IgG 2.7 mm, p = 0.012), less loss of construction of the elastic lamellae, reduction protein expression levels of various inflammatory response including IL-6, TNF-α and MCP-1, a decrease in the number of AIM-positive cells and inflammatory M1 macrophages (AIM: 1.4 vs. 8.0 %, p = 0.004, M1 macrophages: 24.5 vs. 55.7 %, p = 0.017), and higher expression of caspase-3 (22.8 vs. 10.5 %, p = 0.019) in the aortic wall.

Conclusions:
Our results suggested that anti-AIM antibody therapy mitigated AA progression by controlling inflammation and promoting apoptosis.
Abstract 13340: Contractility and Local Stress Patterns Depend on Directionality of Fibrosis Progression: Insights From Microscale Biomechanical Simulations
Authors: Telle Aashild , Maleckar Mary , Sundnes Joakim , Wall Samuel T , Boyle Patrick M
Published: December 2023

Introduction:
Cardiac fibrosis, a common pathological process in heart disease, leads to reduced contractility and increased myocardial stiffness. However, it remains unclear how various cellular and subcellular events individually contribute to these changes.

Hypothesis:
Tissue-scale biomechanical effects resulting from cellular and subcellular changes, such as myocyte loss and increased ECM stiffness, are anisotropic and depend on the prevailing direction of fibrosis progression.

Methods:
We used a mechanical modeling framework allowing for explicit geometrical representation of individual myocytes embedded in ECM. We used a transversely isotropic hyperelastic formulation for the cells while assuming the ECM to be isotropic. Contraction was imposed in each cell using an active stress model.

In a simulated tissue domain (6х12 cells), we explored different cellular configurations (Fig. 1A) representing longitudinal, transverse, and random fibrosis progression (i.e., myocyte loss). In each configuration, we examined tissue shortening and stress distributions subject to original and 10х increased ECM stiffness.

Results:
Myocyte loss perpendicular to the myofiber direction had the largest impact on contractility (Fig. 1B and 1C; as low as 10.8% shortening vs. 15.4% at baseline). In particular, transverse stresses were greatly perturbed in areas near where remaining cells met replacement matrix. Longitudinal and random fibrosis progression had less impact on contractility but led to dramatic heterogeneity in stress distributions. Increased matrix stiffness (Fig. 1C) led to increased magnitude of all stress values.

Conclusions:
Tissue-scale changes depend on both ECM stiffening and the directionality of myocyte loss. Our model predicts that transverse fibrosis progression has the greatest impact on myocardial contraction, while longitudinal and random progression induce higher local maxima in myocardial stress distributions.
Abstract 13361: The Effect of Electronic Cigarette Exposure on Flow Mediated Vasodilation and LV Remodeling in a Chronic Myocardial Infarction Model
Authors: Dai Wangde , Shi Jianru , Carreno Juan , Kleinman Michael T , Herman David , Johnson Rebecca , Renusch Samantha , Hasen Irene , Ting Amanda , Kloner Robert A
Published: December 2023

Introduction:
There is little information about the effect of electronic cigarette (e-C) exposure on the cardiovascular system in the setting of myocardial infarction (MI) and whether e-C’s could alter vascular or cardiac function during the healing phase of MI. We determine the effect of e-C on endothelial function, cardiac remodeling and function during the healing phase of MI.

Methods:
Sprague Dawley rats (both sexes) were anesthetized and subjected to a proximal left coronary artery occlusion to induce a large anterior wall MI. At one week, rats were randomized to receive either 12 weeks of exposure to purified air (n=37) or e-cig vapor plus 15 mg/ml of nicotine (e-Cn=32). At 12 weeks endothelial function was tested by assessing femoral artery diameter and blood flow following a 5- minute femoral artery occlusion and reperfusion (ultrasound and flow probe). Cardiac function was assessed by echocardiography; remodeling was also assessed by quantitative histologic analysis.

Results:
Baseline blood flow in the femoral artery did not differ between groups, but peak reperfusion blood flow was blunted in the e-Cn group (1.59 ± 0.15 ml/min) vs. the air group (2.11 ± 0.18 ml/min; p=0.034). Femoral artery diameter after reperfusion was narrower in the e-Cn group (0.54 ± 0.02mm) compared to the air group (0.60 ± 0.02mm; p=0.023). Postmortem left ventricular (LV) volumes were similar in the e-Cn (0.69 ± 0.04 ml) and air groups (0.73 ± 0.04 ml; p=NS); and myocardial infarct expansion index did not differ between groups (1.4 ± 0.1 in e-Cn group versus 1.3 ± 0.1 in air group; p=NS). Gross pathology LV wall thickness was greater in the e-Cn group (1.38 ± 0.12 mm) versus the air group (1.04 ± 0.10 mm) despite no increase in blood pressure at 12 weeks in the e-CN group. LV fractional shortening by echo did not differ between groups at 12 weeks (e-Cn at 29 ± 2% and air at 27 ± 1%; p=NS).

Conclusion:
Exposure to e-Cn during the healing phase of MI was associated with altered endothelial function with reduced femoral artery blood flow and diameter at reperfusion, but not with worsened LV dilation or worsened cardiac function. E-Cn did increase gross pathologic LV wall thickness. E-Cn exposure during the healing phase of MI has deleterious effects on the CV system but does not dilate the LV.
Abstract 13368: Availability of PGE1 in Northern California Hospitals: Before and After Routine CCHD Screening
Authors: DeRose Lesje , Patel Hitendra
Published: December 2023

Introduction:
Fetal echocardiogram and critical congenital heart disease (CCHD) screening has improved early detection of CCHD. CCHD screening has been recommended for all infants since 2011 and mandated in California since July 2013. In patients with suspected ductal dependent congenital heart disease, early intervention with prostaglandin E1 (PGE1) is the standard of care to reduce morbidity and mortality.

Hypothesis:
In 2004, we assessed the availability of PGE1 in Northern California hospitals that care for newborn infants and found that 32% of hospitals with obstetric services did not have the ability to institute PGE1 infusion. As California has adopted CCHD screening for all newborn infants prior to hospital discharge, our aim was to assess the percentage of hospitals that perform CCHD screening as well as reassess PGE1 availability. Our hypothesis was that CCHD screening would increase the availability of PGE1 at hospitals providing obstetric services.

Methods:
The initial study contacted 117 Northern California hospitals to determine PGE1 availability. We contacted the same hospitals, ending up with 106 hospitals due to closures and mergers. The newborn nursery and/or NICU for each of these hospitals was contacted to determine CCHD screening practices and availability of PGE1. Mileage to the nearest level IV NICU was used as a gross estimate of distance to a tertiary care center.

Results:
In 2004, 92 of 117 hospitals had obstetric service, and 30 (32.6%) of those did not have PGE1. In this study, 74 of the 106 provided obstetric services. All performed CCHD screening, but 15 (20.3%) did not have ability to provide PGE1 infusion. 8 of the 15 hospitals were more than 30 miles (range 1.5 - 192 miles) from the closest level IV NICU.

Conclusions:
All hospitals in Northern California providing obstetric service are performing CCHD screening. However, 20.3% of these hospitals still do not have the ability to administer PGE1 infusion. Of these, 53% were in suburban and rural areas of Northern California, with significant transportation distance to a tertiary care center. Delay in initiating PGE1 infusion in patients with ductal dependent CCHD may lead to morbidity or mortality, and increasing PGE1 availability is an opportunity to improve access to care.
Abstract 13371: Left Bundle Branch Area Pacing: Experiences From the First Two Years Implanting in an Academic Training Program
Authors: Ashur Carmel , Zirelle Francis , Aleong Ryan , Varosy Paul D , West John , Sandhu Amneet , Tumolo Alexis , Rosenberg Michael , Sabzwari Syed Rafay Ali , Barrett Christopher , Cerbin Lukasz , Saqi Bilal , Varela Daniel , Zipse Matthew , Tzou Wendy , Garg Lohit
Published: December 2023

Background:
Left bundle branch area pacing (LBBAP) has emerged as a more durable physiologic pacing strategy to His bundle pacing and a promising alternative to cardiac resynchronization therapy. Integration of this procedural technique within an academic training program has not yet been described.

Objective:
Highlight the procedural learning curve of implanting LBBAP leads within a fellowship program.

Methods:
Retrospective analysis of consecutive patients who underwent placement of a Medtronic 3830 lead for LBBAP at our institution from 1/2021-12/2022.

Results:
A total of 180 patients underwent LBBAP lead placement over the study time period. Overall, total procedure time was 133.7±58.2min, lead placement time 30.7±20.0min, fluoroscopy time 22.5±21.2 min, left bundle branch (LBB) capture rate 70% and paced QRS duration 128.6±19.3 ms. When dividing the study period by 6-month intervals, there was a rise in procedural volume (21, 28, 62 and 59 cases, respectively), a trend towards less fluoroscopy use (20.2±12.2, 16.7±9.1, 16.2±12.6 and 16.6±14.4 min), less total radiation (345.2±323.3, 317.2±630.9, 214.9±271.2 and 171.7±253.9 mGy), decreased LBBAP lead placement time (37.8±24.3, 30.7±16.3, 28.2±21.5, 30.6±18.7 min), decreased delivery system exchanges (19%, 11%, 8% and 2%*, *p≤0.01 from first six months) and improved LBB capture rates (50%, 69%, 83%*, 64%, *p≤0.01 from first six months). Both fellowship classes showed significant improvements in LBB capture rates (40% to 94% and 38% to 84%, p≤0.01 for both) and paced-QRS duration (140.0±27.2ms to 120.2±16.5ms and 136.2±21.8ms to 121.7±17.2ms, p≤0.05 for both) after 12 months of experience.

Conclusion:
Over the first two years of performing LBBAP in an academic training program, there was a rise in procedural volume with trends towards less fluoroscopy use, decreased LBBAP lead placement time with significantly decreased delivery system exchanges and improved LBB capture rates. Significant improvements in LBB capture rates and paced-QRS duration were seen by fellows after 12 months of experience. LBBAP is an increasingly popular pacing technique that can be effectively integrated within a training program, with early introduction important to accommodate the initial learning curve.
Abstract 13378: Identifiable Differences in Comorbidities and Surgical History Among Asian, Native Hawaiian, and Pacific Islander Stroke Patients With Carotid Artery Disease
Authors: Lee Anson Y , Jahansooz Julia R , Borrello Kirra , Trinh Michelle , Weldon Edward J , Ishikawa Kyle M , Ahn Hyeong Jun , Carrazana Enrique , Viereck Jason C
Published: December 2023

Introduction:
A detailed characterization of comorbidity prevalence among carotid artery disease patients has not been thoroughly explored in Asian, as well as Native Hawaiian and Pacific Islander (NHPI) populations.

Research Question:
This study investigated the types of comorbidities and surgical procedures associated with carotid artery disease in Asian and NHPI populations.

Methods:
This retrospective study utilized data from a stroke treatment center in Hawaii between the years 2020-21. Patients were identified with ICD-10 codes for stroke and only those ≥18 years old with either a completed carotid artery Doppler ultrasound or carotid angiography were included in the study. Collected data included demographics, location of stroke, degree and location of carotid stenosis, comorbidities, and previous surgical history. Wilcoxon rank sum test and Fisher's exact test were used as appropriate.

Results:
Overall, 117 patients were included with 74 of identifiable race (45% NHPI, 32% Asian, and 23% White). The average age at the time of stroke was 69 years and 40.0% (47/117) of patients were female. Amongst all races, there were no differences in the greatest degree of carotid stenosis (p=.15) or location of stenosis along the right carotid artery (p=.16), but there was a difference in the location of left carotid stenosis (p=.04). Endocrine conditions were the only comorbidity identified at significantly different rates between all racial groups (p=.02). Prior cardiac (p=.03), otolaryngological (0=.007), and orthopedic (p=.01) procedures differed significantly by race among the cohort. The majority of these differences were present when comparing NHPI or Asian patients against White patients, with no significant differences found between Asian and NHPI patients.

Conclusions:
Asian and NHPI stroke patients were found to have significantly different rates of left carotid stenosis, endocrine conditions, and prior cardiac, otolaryngological, or orthopedic surgeries when compared to White patients. Due to these race-specific differences in patient demographics and history, the implementation and investigation of carotid artery disease risk assessments should be pursued to best improve stroke outcomes among all patients.
Abstract 13419: Transient Coronary Artery to Left Ventricular Fistula With Diastolic Mitral Regurgitation
Authors: Misumi Ikuo , Miyanaka Kei , Hazekawa Iwaho , Sato Koji , Tabira Akihisa
Published: December 2023

Introduction:
A fistula from a coronary artery to the cardiac chamber is incidentally found in 0.08% to 0.3% of patients undergoing coronary angiography.

Case Presentation:
A 73-year-old woman with hypertension, diabetes mellitus, chronic renal failure, and nephrosis visited our department due to dyspnea. The patient’s physical examination revealed a blood pressure of 191/109 mmHg and a pulse rate of 77 beats per min. The blood sampling results revealed a plasma brain natriuretic peptide level of 2,001 pg/mL. A 12-lead electrocardiogram showed poor R wave progression in leads V1 to V4. Chest radiography revealed left pleural effusion. Parasternal transthoracic echocardiography showed left ventricular hypertrophy. Left ventricular (LV) ejection fraction was 41%. A pulsed-wave Doppler echocardiography at the mitral inflow showed diastolic mitral regurgitation and a fusion of E and A waves. An unusual myocardial flow was noted in the apical myocardium. It was directed toward the apical surface during systole (Fig. 1a), and directed toward the LV lumen during diastole (Fig. 1b), suggesting coronary artery to LV fistula through sinusoid. Global strain obtained from apical long axis imaging showed myocardial shortening continued to diastole, suggesting post-systolic shortening (PSS). After treatment for hypertension, both of myocardial flow and diastolic MR disappeared. A longitudinal global strain imaging revealed disappearance of PSS.

Conclusion:
This is a rare case of diastolic MR due to PSS at the fistula from the coronary artery to the left ventricle.
Abstract 13434: Prognostic Impact of Functional Limitations in Acute Decompensated Heart Failure Patients With Reduced & Preserved Left Ventricular Ejection Fraction
Authors: Fujita Takeshi , Yamada Takahisa , Watanabe Tetsuya , Morita Takashi , Kawasaki Masato , Kikuchi Atsushi , Kondo Takumi , Kawai Tsutomu , Nishimoto Yuji , Chang Yongchol , Taniichi Masanao , Oshita Takuya , Kokubu Yuki , Fukuda Yuto , Kinugawa Makoto , SHIMIZU KENTARO , Sakai Katsuyoshi
Published: December 2023

Background:
Although functional limitations (FL) could predict clinical status in patients with heart failure (HF), these clinical significances have not been fully elucidated.

Hypothesis:
Severe FL would be associated with poor prognosis both in patients with HFrEF and HFpEF.

Aims:
The purpose of this study was to examine the prognostic significance of FL in patients with acute decompensated heart failure (ADHF), relating to left ventricular ejection fraction (LVEF).

Methods:
We studied 340 patients admitted for ADHF in our prospective cohort study (Osaka Prefectural Acute heart failure Registry: OPAR study)(HFrEF[LVEF≤50%]:n=175 and HFpEF[LVEF>50%]:n=165). Clinical data, echocardiography and venous blood sampling were performed just before discharge. FL were evaluated using the Performance Measure for Activities of Daily Living-8 (PMADL-8 ranges 8-32, and higher scores indicate worse FL). The endpoint was the composite of worsening heart failure rehospitalization and cardiac death.

Results:
During a follow up period of 3.0±1.9 years, 123 patients (64 patients in HFrEF and 59 patients in HFpEF) reached the primary endpoint. PMADL-8 was significantly smaller in patients with HFrEF than HFpEF (18.9±7.1 vs 21.0±6.1, p=0.004). On multivariate Cox analysis, PMADL-8 score was an independent risk factor for the primary endpoint both in HFrEF and HFpEF after adjustment for major confounders (age, sex, systolic blood pressure, and plasma brain natriuretic peptide level). Patients with high PMADL-8 scores had a higher risk of the primary endpoint than those with low PMADL-8 scores both in HFrEF (≥16 defined by ROC analysis, AUC 0.590[0.503-0.676]; adjusted hazard ratio: 2.20 [95%CI 1.08-4.48], 43% vs 25%, p=0.03) and HFpEF (≥25 defined by ROC analysis, AUC 0.617 [0.528-0.707]; adjusted hazard ratio: 1.95 [95%CI 1.04-3.66], 50% vs 29%, p=0.04).

Conclusion:
FL evaluated based on PMADL-8 was associated with poor prognosis in ADHF patients with both HFrEF and HFpEF.
Abstract 13435: The Efficacy and Safety of Botulinum Toxin Type A to Prevent Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials
Authors: Abdelazeem Basel , Kambalapalli Soumya , Saleh Othman , M. AlBarakat Majd , Gowaily Ibrahim , Mahmoud Abdelrahman , Ali Shafaqat , Abuelazm Mohamed T
Published: December 2023

Background:
Postoperative atrial fibrillation (POAF) is prevalent in about 30 to 60 percent of patients undergoing cardiac surgery leading to worse outcomes. However, effective POAF therapies are lacking. Botulinum toxin type A (BTX) epicardial injection can prevent POAF by impairing cholinergic signaling.

Methods:
We conducted a systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching: PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane through November 23
rd
, 2022. RevMan version 5.4 software was used to pool dichotomous outcomes using risk ratio (RR) and continuous outcomes using mean difference (MD) presented with the corresponding confidence interval (CI).

Results:
Three RCTs with a total of 509 patients (308 in the BTX group and 205 in the placebo group) were included in our analysis. Two RCTs included patients undergoing open-chest cardiac surgery, including coronary artery bypass graft (CABG) and/ or valve surgery, while one RCT included patients undergoing CABG only. There was no difference between BTX and placebo regarding POAF incidence (RR: 0.81 with 95% CI [0.65, 1.00], P= 0.05), postoperative hospital length of stay in days (MD: -0.03 with 95% CI [-0.54, 0.49], P= 0.91), all-cause mortality, (RR: 1.64 with 95% CI [0.22, 12.17], P= 0.63), any adverse event (RR: 1.03 with 95% CI [0.94, 1.12], P= 0.51), and any serious adverse event (RR: 0.89 with 95% CI [0.68, 1.15], P= 0.36).

Conclusion:
There was no difference between epicardial fat injection of BTX versus placebo for preventing POAF; however, BTX showed a similar safety profile compared to placebo and our analysis can be underpowered to detect a significant effect. Hence, further large-scale RCTs are warranted to investigate BTX for POAF, especially in high-risk cohorts.
Abstract 13466: Trends in Prevalence of Psychiatric Cardiovascular Risk Factors for Women Veterans
Authors: Ebrahimi Ramin , Sumner Jennifer , Perkins Aaron , dennis paul , beckham jean , Shroyer A. Laurie , Alvarez Carlos
Published: December 2023

Introduction:
Psychiatric disorders such as anxiety, depression, and posttraumatic stress disorder (PTSD) have been increasingly recognized as cardiovascular disease (CVD) risk factors in the past two decades. US women Veterans (WV) are a growing and high-risk population for CVD. The goal of this study was to investigate the prevalence of these psychiatric CVD risk factors among US WV over a two-decade period.

Methods:
The national Veterans Affairs electronic health records were utilized to assess prevalence of the above disorders among US WV who visited a VA facility from 1/1/2000 to 12/31/2019. All diagnoses were based on International Classification of Disease (ICD) 9
th
and 10
th
version diagnostic codes.

Results:
Over the study period, the population of WV grew from 80,707 to 739,309, and the average age of the WV remained stable, 48 (2000) and 49 (2019) years old. Table 1 reveals the prevalence of these psychiatric CVD risk factors over the study period. Prevalence of each psychiatric disorder increased over the study period, with accelerated growth over the last decade of the study period.

Conclusion:
The prevalence and growth of these psychiatric l CVD risk factors among US WV is alarming. Focused research is warranted on potential interventions to reduce, and treat these nontraditional CVD risk factors to improve both psychiatric and cardiovascular health for WV.
Abstract 13481: A Rare Case of Pembrolizumab (Keytruda®) -Associated Thyrotoxicosis Causing Atrial Dysrhythmias
Authors: Bhyan Poonam , Goyal Amandeep , Barker Sarah , tayeb taher , Yarrarapu Siva Naga S , Dalia Tarun , Jakulla Roopesh Sai , Alarfaj Mohammad , Gopinath Chaitra , Shah Zubair , Weiford Brian C
Published: December 2023

Introduction:
Immune-Check-Point Inhibitors such as pembrolizumab (Keytruda®) are associated with the development of several immune-related adverse events.

Case:
70-year-old malewith history of pleomorphic sarcoma of the right lower extremity with metastases to the lungs was started on Pembrolizumab 3 weeks before presenting to the ER with complaints of generalized weakness and palpitations. The patient was tachycardic and EKG showed atrial tachycardia at 144 beats/minute with right bundle branch block (RBBB) (
FIG 1B
). RBBB had been previously noted on EKG (
FIG 1A
). High-sensitivity-troponins were in the range of 29 to 37 ng/l. The TSH on admission was 0.01 mcu/ml with free T4 of 4.7 ng/dl (> twice the upper limit of normal). Of note, TSH was normal prior to the initiation of Pembrolizumab (2.01 ng/dl). Anti-microsomal anti-thyroid peroxidase (TPO) antibodies were also elevated. US thyroid showed heterogeneous thyroid parenchyma concerning for thyroiditis. The patient received multiple doses of IV metoprolol and IV digoxin for rate control before converting spontaneously to normal sinus rhythm, and was then started on metoprolol succinate to maintain the heart rate.

Decision Making:
Based on the patient’s recent history of initiating Pembrolizumab therapy and normal thyroid function before, his thyroid dysfunction was attributed to the immunotherapeutic agent leading to atrial dysrhythmias. Endocrinology team was consulted, and prednisone 40 mg daily was started. Repeat free T4 after 5 days came down to 2.5 ng/dl. The patient was discharged home on oral Metoprolol and slow prednisone taper in the next few weeks and outpatient follow-up with endocrinology.

Conclusion:
Thyroid dysfunction is one of the most common immune-related adverse effects of Pembrolizumab that can cause multisystem dysfunction such as dysrhythmias. Therefore, clinicians should be familiar with their unique adverse effects to minimize morbidity and enable appropriate management.
Abstract 13502: Obesity Paradox in Severe Rheumatic Mitral Stenosis: A Prospective Analysis Using a Machine Learning-Based Approach
Authors: Negrao Pantaleao Alexandre , Mutarelli Antonio , Petrilli Maffei Dardis Thiago , GOUDOT Guillaume , Matheus Faccioli Renata , Brandão de Medeiros Neto Mauri , Sanadgol Ghazal , Yaghoubian Koushiar Moshe , Neves Eula , Marangoni Roschel Marina , Nunes Maria C
Published: December 2023

Background:
The obesity paradox posits that obese patients have better prognosis in cardiovascular diseases. Scarce data exists on the obesity paradox in rheumatic mitral stenosis (RMS)

Hypothesis:
Obesity is associated with a favorable prognosis in severe RMS

Methods:
Patients with severe RMS referred to a tertiary center from 2011 to 2022 were prospectively included. Patients with previous valve interventions were excluded; clinical and echocardiographic data were collected at baseline. Severe RMS was defined as a mitral valve area ≤ 1.5 cm2 by planimetry and patients were divided into 2 groups: (1) BMI ≥ 30 kg/m
2
; (2) BMI < 30 kg/m
2
. A combined outcome of percutaneous mitral valvuloplasty, mitral replacement and cardiovascular death was set. Logistic regression adjusted for confounders and gradient boosted decision-tree analysis were used

Results:
A total of 315 patients (82.2% female, mean age 53.3 years) were included. Over a median follow up of 30 months, 87% of patients had the outcome. MVA was higher in group 1 (p<0.001) while left atrial volume index (LAVi) and net atrioventricular compliance were lower (p=0.008 both). Overall, BMI was not a good independent predictor of outcome (OR 0.98, 95% CI: 0.91-1.06, p=0.50) and occurrence of outcome was similar between groups (p=0.481). In both groups, mean importance of BMI in determining the outcome was similar (17.7 ± 6.1% and 17.0 ± 2.6% respectively)

Conclusion:
Obese patients had higher MVA and lower LAVi. However, our data suggests that BMI was not a significant independent predictor of poorer prognosis and its importance was not different between the groups. These findings challenge the obesity paradox in severe RMS
Abstract 13528: A Comparison of Five Measures of Accelerated Biological Aging and Their Association With Incident Cardiovascular Disease: The CARDIA Study
Authors: Forrester Sarah N , Baek Jonggyu , Hou Lifang , Roger Veronique L , Kiefe Catarina I
Published: December 2023

Background:
Accelerated biological aging is an increasingly popular way to track the effects of chronic stress over time. Biological aging is linked to external and internal chronic stressors and has the potential to be used clinically to understand a person’s personalized functioning and to predict future disease.

Aims:
The primary aim was to investigate the similarities and differences in the association of different measures of biological aging and incident cardiovascular disease (CVD).

Hypotheses:
Our novel predictor, Clinical Marker-Derived Age Acceleration (CAA), and the Framingham Risk Score (FRS) will be most robustly associated with incident CVD, and the associations will be stronger among Black participants. The latter is based on previous findings that Black participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study have, on average, more adverse social determinants of health.

Methods:
We used Multiple Informants Models (MIM) to compare the strength of five measures of accelerated aging (Intrinsic and Extrinsic Epigenetic Age Acceleration, GrimAge Acceleration, PhenoAge Acceleration, CAA (including clinical biomarkers, e.g., CRP, lung function, glucose, etc.), and one established clinical predictor of future CVD, FRS, to predict incident CVD over 11 years (2007 – 2018). Participants were 913 Black or White individuals examined by CARDIA in 2005-2006, when their mean age was 45 years. We also included race-specific analysis. Measures were standardized (M = 0, SD=1) to facilitate comparison.

Results:
The incidence rate of CVD within our sample was 7.8 per 1,000 person years and the prevalence of CVD was 7.5%. CAA and FRS significantly predicted incident CVD in the fully adjusted model (OR = 1.31, 95% CI: 1.06 – 1.63) and (OR = 1.28, 95% CI: 1.05 – 1.56), respectively. CAA and FRS were the best predictors of CVD, but there was no significant difference in the predictive value of CAA and FRS (Chi2 = 0.05, p = 0.828). In race-stratified models, CAA was the strongest and most consistent predictor in the Black-only models.

Conclusions:
Our findings support the association of CAA, a multi-system clinical composite, with incident CVD. Further, this composite may account for some of the well-known racial variation in incident CVD.