bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18737: Coronary Artery Calcium for Allocation of Aspirin in Light of the 2022 USPSTF Guideline Recommendations: Results From the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Verghese Dhiran , Boakye Ellen , Blaha Michael J , Manubolu Sanjay , Aldana Jairo , Kinninger April , Dardari Zeina A , Cubeddu Robert , Albaghdadi Mazen , Miedema Michael D , Yeboah Joseph , Roy Sion , Cainzos Miguel , Budoff Matthew J
Published: December 2023

Introduction:
The 2022 USPSTF guidelines issued a grade C recommendation for aspirin in patients aged 40-59 and recommended against its use in patients ≥ 60 years. We sought to assess if coronary artery calcium (CAC) would allow for personalized allocation of aspirin.

Methods:
Using MESA, aspirin naïve participants without high-risk bleeding features were identified. Participants were grouped by age into <60, ≥ 60 and stratified by CAC and ASCVD risk. The number needed to treat (NNT
5
) and number needed to harm (NNH
5
) was assessed by applying a 11% relative risk reduction in CVD and a 44% relative risk increase in major bleeding (2022 USPSTF meta-analysis) to the observed CVD and bleeding events from MESA

Results:
Of 6,814 participants, 4,506 met inclusion criteria. 2,235 were <60 years and 2,268 were ≥ 60 years. Figure-1 displays the interplay between baseline estimated ASCVD risk and CAC burden. In participants <60 years of age, both CAC and ASCVD risk >10% identified subgroups in whom the NNT was lower than the NNH: CAC 1-99 (NNT
5
-313, NNH
5
-517); CAC ≥100 (NNT
5
-152, NNH
5
-367); ASCVD risk >10% (NNT
5
-155, NNH
5
-554) Fig-1. In those ≥ 60 years CAC ≥100 identified subgroups with a lower NNT
5
-128 than NNH
5
-168, while ASCVD risk stratification did not. 6% of adults <60 years with <10% ASCVD risk and 30.3% of adults ≥ 60 years who had CAC ≥100, and who demonstrated benefit from the use of Aspirin, would not qualify for the use of aspirin using only ASCVD risk as per the 2022 USPSTF guideline recommendations.

Conclusions:
CAC identifies subgroups of patients <60 as well as those ≥ 60 years who would derive a net benefit from aspirin in primary prevention. A significant proportion of patients will be missed if only ASCVD risk scores are used for allocation of aspirin. CAC should be used to risk stratify individuals to personalize the allocation of aspirin
Abstract 18738: 3D Speckle Tracking Echocardiography in Radiation-Associated Cardiac Disease and Associated Mortality Outcomes
Authors: El Dahdah Joseph , Kafil Tahir , Tereshchenko Larisa G , Alashi Alaa , Ospina Susan , Xu Samantha , donnellan eoin , Unai Shinya , Reed Grant W , Kapadia Samir R , Griffin Brian P , Desai Milind Y
Published: December 2023

Introduction:
The 2D echocardiographic features of radiation-associated cardiac disease (RACD) are well-described including aorto-mitral curtain thickness. However, the 3D speckle tracking echocardiographic strain patterns and their predictive risk for all-cause mortality are not well known in RACD.

Methods:
We studied 441 patients with RACD (63.7 ± 13.4 y; 62.4% female) seen in our institution. Echocardiographic strain patterns of their initial echocardiograms were reviewed. 3D strain analysis using TOMTEC was performed for left ventricle (LV), right ventricle (RV), and left atrium (LA). Primary outcome was all-cause mortality. We constructed 3 Cox regression models: (1) unadjusted; (2) minimally adjusted for age and sex; (3) adjusted for 42 covariates including CV risk factors, cancer history, cardiac treatments, and cardiac function.

Results:
During a median 6.8 (95%CI 5.7-7.4) years follow-up, 245 patients died. In the unadjusted model, all LV, RV, and LA strain metrics (except for RV free wall strain) were significantly associated with all-cause death. After comprehensive adjustment for 42 covariates, the strain metrics (except for left atrial contraction strain) remained significantly associated with mortality. The strongest predictor for mortality was reduced LV GLS (HR 0.93, 95%CI 0.89-0.96; p <0.001).

Conclusions:
Abnormal strain patterns in patients with RACD were associated with increased all-cause mortality independently from other known risk factors. Abnormal strain is a distinct feature of radiation-induced cardiac disease, possibly indicating the mechanism of radiation associated cardiac disease.

(JED and TSK are first Co-authors)
Abstract 18751: Emerging Frontiers in Hypertension Management: Consensus on Novel Approaches for Optimal Control
Authors: Hiremath MS , Ponde Chandrashekhar , Jaswal Rakesh , Kapoor Aditya , Sinha Nakul , Trehan Vijay , Saha Arabinda , Kannan K , Borges Eric ,   3B Consensus Group
Published: December 2023

Introduction:
To establish a comprehensive consensus statement on hypertension management, incorporating contemporary evidence and drawing from the valuable real-world experiences of Indian physicians and cardiologists

Methods:
A virtual collaborative educational initiative was convened in May 2023, through a series of 8 nationwide virtual interactive meetings (n=87) at the forefront of hypertension care (3B Consensus Group). The cumulative clinical experience was approximately 2,500-man-years, who rated their level of agreement for 10 questions with each item on a 5-point Likert scale. This was preceded by a contemporary evidence-based discussion on the contemporary updates for hypertension. Weighted mean for the Likert scale was calculated and consensus was pre-defined as a score > 100. GraphPad 9.5.1 and ANOVA were used for statistical analysis.

Results:
The highest agreement score was for, hypertension is an important cardiovascular risk factor in CKD (127.1), bisoprolol with conventional treatment is efficacious for managing MI and cardiac insufficiency (126.8), because of considerable variability in BP response to different drugs, personalized treatment approaches are essential to optimize the effectiveness of BP reduction (118.3), research is warranted to explore the importance of salt awareness in patients with hypertension (117.4), beta blockers including bisoprolol in the treatment of MI complicated with cardiac insufficiency effectively reduce cardiotoxicity, enhance myocardial response (114.4), treatment guided by ABPM can enhance outcomes (102.7) (Figure). The highest mean response scores (±SD, 95% CI) for consensus were for strongly agree (52.6±28.6, 95% CI 32.1 to 73) followed by agree (50.8±13.4, 95% CI 41.2 to 60.4)

Conclusions:
The physicians and cardiologists establish hypertension management consensus, emphasizing cardiovascular risk, bisoprolol efficacy, personalized treatment, salt awareness, and ABPM
Abstract 18759: Reliability and Accuracy of Non-Invasive versus Invasive Blood Pressure Monitoring During Atrial Fibrillation Ablation
Authors: AlSadawi Mohammed , Kalogeropoulos Andreas P , Mattimore Daniel , Singh Abhijeet , Schwartz Jonathon
Published: December 2023

Introduction
Patients with atrial fibrillation (AF) have multiple confounders that could affect the reliability of non-invasive blood pressure (NIBP). We sought to investigate if AF and paced rhythms (PR) modify the reliability of NIBP and accuracy against an invasive blood pressure (IBP) reference, as compared to sinus rhythm (SR), and impact NIBP validity for procedural monitoring.

Hypothesis
Changes in heart rhythm between AF, SR and PR, within a patient would not alter the reliability and accuracy of NIBP.

Methods
We conducted an observational study in patients undergoing an AF ablation procedure under general anesthesia with paired IBP, NIBP, and heart rhythm measurements available.

Results
We evaluated 91 patients (
Table 1
) with 1,179 usable NIBP vs. IBP pairs; 547 (46.4%) during SR, 376 during AF (31.9%), and 256 (21.7%) during PR. In the entire sample, the average difference (standard error) between systolic NIBP and IBP was 2.9 (1.8) mmHg (P=0.10 against H0=0) with a within-subject standard deviation (SD) for the difference of 11.6 mmHg and intraclass correlation coefficient of 0.76 (
Fig. 1
). Systolic NIBP was higher on average vs. IBP when in SR (6.2 [1.1] mmHg; P<0.001), but not when in AF (1.5 [2.6] mmHg; P=0.55) or in PR (-2.0 [3.3] mmHg; P=0.54). However, the within-patient SD of the difference was high in SR, AF, and PR (SD 10.5, 12.9, and 11.9 mmHg, respectively). Results were similar for diastolic and mean NIBP vs. IBP.

Conclusion
AF or PR, as compared to SR, did not materially change the reliability and accuracy of NIBP vs. IBP. However, the high within-patient variation in systolic NIBP versus IBP raises concerns on the validity of NIBP for systolic blood pressure monitoring.
Abstract 18770: Understanding Patients’ Characteristics and Coronary Microvasculature: Early Insights From First US Coronary Microvascular Dysfunction Registry
Authors: Merdler Ilan , Case Brian , Medranda Giorgio A , Ben-Dor Itsik , Waksman Ron , Hashim Hayder
Published: December 2023

Introduction:
Coronary angiography falls short in accurately evaluating the coronary microcirculation. Fortunately, a new comprehensive invasive hemodynamic assessment method, which uses coronary flow reserve (CFR) and the index of microvascular resistance (IMR), provides enhanced diagnostic capabilities.

Objective:
We present our early real-world experience with invasive hemodynamic assessment of the coronary microvasculature in symptomatic patients with non-obstructive coronary artery disease (CAD) from the first US Coronary Microvascular Disease Registry (CMDR).

Methods:
The CMDR is a prospective, multi-center, standardized registry of patients with angina and non-obstructive CAD who underwent invasive hemodynamic assessment of the coronary microvasculature using the Coroventis CoroFlow Cardiovascular System (Abbott Laboratories, Chicago, Illinois). Comprehensive assessments, including resting full-cycle ratio (RFR), fractional flow reserve (FFR), CFR, and IMR, were performed on all patients.

Results:
The first 156 patients enrolled in the CMDR were analyzed; their mean age was 62.4 years and 65.6% were female. A substantial proportion (31.8%) of patients presented with a Canadian Cardiovascular Society Angina Score of 3 or 4. CMD was diagnosed in 39 of 154 patients (25.3%), with mean RFR of 0.89±0.43, mean FFR of 0.93±0.08, mean CFR of 1.8±0.9, and mean IMR of 36.26±19.23. None of the patients experienced in-hospital adverse events.

Conclusions:
Early results from CMDR patients show that invasive hemodynamic assessment of the coronary microvasculature is safe and effective for suspected CMD. Tailored medical therapy for microvascular angina was provided to diagnosed CMD patients. With ongoing patient enrollment, the CMDR aims to contribute valuable insights to the growing evidence base for CMD.
Abstract 18793: Demographic and Regional Trends in Mortality From Cardiac Arrest in the USA From 1999-2020
Authors: Mannumbeth Renjithlal Sarath Lal , Eid Mohamed M , Cordeiro Nikhil , Shanker Dinesh Abhijeeth , Eid Fahad , Abdou Claudine , Shanmukhappa Sanjana , Hollander Gerald
Published: December 2023

Introduction:
Cardiac Arrest (CA) is a major public health problem associated with high mortality. We aim to assess the demographic and racial trends of mortality associated with CA between 1999 and 2020.

Methods:
A cross-sectional analysis of the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiological Research database (CDC-WONDER) was conducted to investigate the trends in mortality associated with CA (ICD codes -I46.0, I46, I46.9, and I49.0).

Using Joinpoint regression analysis, the study calculated age-adjusted mortality rates (AAMR) per 1,000,000 individuals and corresponding annual percentage changes (APC), along with 95% confidence intervals. Demographic and racial trends were evaluated.

Results:
394,021 CA-related deaths occurred from 1999 to 2020. Annual trends show that the AAMR reduced from 8.3 (95% CI 8.2-8.4) in 1999 to 4.7(95% CI 4.6-4.8) in 2020. The overall AAMR from 1999-2018 had an Annual Percentage Change (APC) decrease of -2.0 (95% CI: -2.4 to -1.6). From 2012 to 2020, the APC was 0.4(95% CI: -0.3 to 1). When stratified by sex, males had a worse AAMR at 6.4 (95% CI: 6.4-6.4), and women were found to have an AAMR of 4.5 (95% CI: 4.4-4.5). When stratified by ethnicity, AAMR was highest among African Americans at 9.3 (95% CI: 9.2-9.3), followed by White at 5.0 (95% CI 5.0-5.0), followed by Asian or Pacific Islanders at 3.6(95% CI 3.5-3.7) and American Indian or Alaska Native patients at 3.0 (95% CI2.9-3.2). When stratified by geographical area, Non-metro, rural areas had worse AAMR than urban areas.

Conclusions:
There has been a general decrease in CA-associated mortality from 1999 to 2012 in the United States. However, since 2012, the mortality has been stable and not improving. Our data shows that the AAMR is worse in men, African Americans, and rural populations. In the setting of no improvement of AAMR since 2012, further research is needed to identify the causes and potential strategies to improve AAMR.
Abstract 18796: Predictors of Repeat Ablation in DECAAF-II Patients
Authors: Chouman Nour , Assaf Ala' , Younes Hadi , Mekhael Mario , Noujaim Charbel , Makan Noor , Lim Chanho , Feng Han , donnellan eoin , Kreidieh Omar , Pandey Amitabh C , Marrouche Nassir
Published: December 2023

Introduction:
Post-ablation arrhythmia recurrences are common, yet the incidence of Repeat Ablation (RA) in patients with Persistent Atrial Fibrillation (PeAF) is under-investigated and it remains unclear whether RA can be predicted.

Hypothesis:
We looked for associations between certain patient/disease characteristics, and RA incidence.

Methods:
Using the DECAAF-II trial database, we divided PeAF patients into 2 groups: with or without RA. We compared them for: demographics & comorbidities, baseline left atrial (LA) myopathy (reflected by LGE-MRI-detected LA fibrosis %, & LA volume), the duration in days between AF diagnosis & ablation, and ablation type (PVI Vs PVI + fibrosis-guided). The smart AF burden “Smurden” during the 3 months blanking period, defined by the % of days with detected AF over the total ECG monitoring duration, was also analyzed. Using a p-value cut-off of 0.3, variables were retained then included in a multivariate logistic regression model.

Results:
732 patients were included. Demographics, comorbidities, & other parameters are reported in Table1. Bivariate associations with p<0.3 were found: LA volume in mm
3
was significantly higher in patients with RA: 139.41 vs 129.54, p = 0.012; history of stroke and CABG were more common in RA with ORs respectively: 1.661, p = 0.111; 2.891, p = 0.096; RA incidence was higher in the PVI only group: OR = 0.77, p = 0.2; the Smurden was higher in RA patients: 33.68 % vs 12.55 %, p <0.001. The multivariate analysis showed one significant predictor of RA: Smurden OR: 9.413, CI 4.831- 18.343, p<0.001(Figure1).

Conclusions:
High AF burden during the blanking period was a significant predictor of RA in PeAF patients.
Abstract 18812: Premortem Risk Assessment Among Countywide Sudden Deaths
Authors: Nakasuka Kosuke , Eik David , Yee Matthew , Kinkead Brielle , Connolly Andrew , Moffatt Ellen , Tseng, MD Zian
Published: December 2023

Introduction:
Heart failure (HF) and left ventricular ejection fraction (EF) assessment have been hallmarks of sudden cardiac death (SCD) risk stratification for over 20 years. However, their sensitivity, specificity, and positive predictive value (PPV) for true arrhythmic death in the general population are unknown because nearly all SCD studies presume arhythmic causes.

Aims:
To define sensitivity, specificity, and PPV of current SCD risk stratification criteria for the autopsy-confirmed arrhythmic cause among countywide sudden deaths.

Methods:
POST SCD (POstmortem SysTematic Investigation of Sudden Cardiac Death) is a prospective cohort study using autopsy, clinical records, and toxicology to adjudicate arrhythmic (SAD; potentially rescuable with implantable defibrillator) or non-arrhythmic (non-SAD; e.g., tamponade, overdose) causes among presumed SCDs (pSCDs) in San Francisco County. We analyzed sensitivity, specificity, and PPV for syncope, EF≤35%, diagnosed HF, or the presence of any of 3 factors to discriminate SADs among pSCDs.

Results:
Between February 2011 and September 2022, 845 of 904 (93%) pSCDs 18-90 years had complete medical records available, of which 491 (58%) were SADs. Seventy-three pSCDs had history of syncope, with similar prevalence in SADs and non-SADs (p=0.4), while prevalence of HF was higher in SADs vs. non-SADs (88/491[18%] vs. 39/354 [11%], p=0.003). EF assessment was performed in 206 pSCDs (24%, 133 SADs, 73 non-SADs); prevalence of EF ≤ 35% was similar between SADs and non-SADs (p=0.112). A greater proportion of SADs had ≥1 factor than non-SADs (122/491[25%] vs. 65/354 [18%], p=0.015). Sensitivity of syncope, EF≤35%, HF, ≥1 factor for SAD was 9, 26, 17, 25%, specificity was 92, 82, 90, 82%, and PPV was 60, 73, 69, 65%, respectively. Conversely, 369 of 491 (75%) SADs had no risk factors before sudden death. Defibrillators were implanted in 4/491 (0.8%) SADs.

Conclusions:
In this 11-year countywide postmortem study, conventional risk factors had low sensitivity and PPV but high specificity for autopsy-confirmed arrhythmic cause of sudden death. Three-fourths of SADs had no risk factors before sudden death, highlighting the need for improved risk prediction in the general population.
Abstract 18816: Association Between Perceived Exertion Intensity of Physical Activity and Agiographic Score in Patients With Coronary Artery Disease: A Pilot Study
Authors: Acacio Brenda , Battaglia Filho Antônio Carlos , Fonseca Guilherme Wesley Peixoto da , Ribeiro de Souza Francis , do Val Renata , Negrão Carlos Eduardo , Kalil Filho Roberto , de Nazaré Nunes Alves Maria Janieire
Published: December 2023

The protective role of physical activity on coronary artery disease (CAD) has been demonstrated by many studies. The influence of physical activity intensity on CAD progression is unknown.

Purpose:
To evaluate the association between physical activity intensity and angiography score.

Methods:
94 patients evaluated, 63 patients with known CAD and 31 patients without CAD who had coronary computed tomography angiography. Muscle strength was measured by handgrip. A pedometer was used to quantify steps/day. Physical activity questionnaire was used to determine physical activity in months and intensity was determined by the modified BORG scale (BORG). Gensini score was used to calculate atherosclerotic load.

Results:
There was no difference between patients with and without CAD for age , systolic blood pressure, diastolic blood pressure, BORG, total steps, and handgrip, respectively. Gensini was higher for patients with CAD than those without CAD [14 (6-24) vs 0 (0-0); p=0.012, respectively. There was a negative correlation between Gensini and week total steps (r=-0.29; p=0.027). Univariate logistic regression model using Gensini>13 as the dependent variable, age (OR, 1.082; 95% CI, 1.012-1.157; p=0.021), moderate-to-high intensity (OR, 0.359; 95% CI, 0.134-0.958; p=0.041), and very vigorous intensity (OR, 4.308; 95% CI, 0.899-20.632; p=0.047) were associated with Gensini, whereas light intensity was not significantly associated with Gensini (OR, 1.218 ; 95% CI, 0.472-3.138; p=0.68). In a multivariate logistic regression model, age (OR, 1.144; 95% CI, 1.039-1.260; p=0.006) and moderate-to-high intensity (OR, 0.316; 95% CI, 0.107-0.931; p=0.037) remained associated with median Gensini>13 adjusted by presence of dyslipidemia, hypertension, diabetes independently, smoking, handgrip strength, week steps, and months of physical activity.

Conclusion:
our results show that only moderate-to-high intensity of physical activity is independently associated with Gensini score, suggesting a protective effect of intensity from moderate to high on progression of coronary alterations.
Abstract 18819: Detection of Systolic Dysfunction in Pediatric Patients Using an Artificial Intelligence-Enabled Electrocardiogram
Authors: Anjewierden Scott , O'Sullivan Donnchadh , Greason Grace , Attia Zachi , Lopez-Jimenez Francisco , Friedman Paul , Noseworthy Peter A , Anderson Jason , Kashou Anthony H , Eidem Benjamin W , Johnson Jonathan N , Niaz Talha , Madhavan Malini
Published: December 2023

Introduction:
Left and right ventricular systolic dysfunction (LVSD and RVSD respectively) contribute to considerable pediatric morbidity. Both LVSD and RVSD can occur in children before symptom onset, emphasizing the need for early detection. Existing deep-learning algorithms can identify LVSD in adults using 12-lead ECG; however, their efficacy in children is uncertain.

Aims:
We aimed to create a deep-learning model for LVSD and RVSD detection in pediatric patients using an AI-enabled ECG and compare novel pediatric models to a previously validated adult LVSD model.

Methods:
We identified 10,214 pediatric patients at the Mayo Clinic with a transthoracic echocardiogram (TTE) and a 10-second, 12-lead surface ECG within 14 days of TTE, performed from 2002 -2022. Our cohort comprised the first TTE-ECG pair from each patient, totaling 138 with EF ≤ 35%, 312 with EF ≤ 50%, 482 with RVSD, and 9,567 without any LVSD or RVSD. The cohort was split into training, validation, and testing datasets to develop neural networks for systolic dysfunction detection.

Results:
The cohort was 52.3% male, with an average age of 10.3 years. Novel models generated in the pediatric cohort demonstrated excellent performance in systolic dysfunction detection (Figure 1). Pediatric models for EF ≤ 35% and EF ≤ 50% achieved test AUCs of 0.92 (95% CI 0.89, 0.95) and 0.89 (95% CI 0.85, 0.94) respectively. The RVSD model reached a test AUC of 0.91 (95% CI 0.88, 0.94). A combined model for EF ≤ 35% or RVSD exhibited a test AUC of 0.90 (95% CI 0.87, 0.93), sensitivity 0.88, specificity 0.82, PPV 0.20, and NPV 0.95. A combined model for EF ≤ 50% or RVSD exhibited a test AUC of 0.88 (95% CI 0.85, 0.91). The previously validated adult data-derived model achieved an AUC of 0.86 (95% CI 0.83, 0.89) for EF ≤ 50% in children.

Conclusions:
AI-enabled ECGs demonstrate efficient detection of both LVSD and RVSD in pediatric patients. Future multi-site validation is needed to further establish the reliability of these models.
Abstract 18837: Association of Urinary Catecholamines and Their Metabolites With the Use of Electronic and Combustible Cigarettes
Authors: Poudel Remy , Li Shen , ROBERTSON ROSE MARIE O , Fetterman Jessica L , Srivastava Sanjay , Hong Haoyun , Zhao Juan , Hamburg Naomi M , Bhatnagar Aruni , Keith Rachel J
Published: December 2023

Nicotine, present in combustible cigarettes, is a strong sympathomimetic drug, and many of the cardiovascular and metabolic effects of smoking have been linked to increases in catecholamine production. However, it is not known whether vaping also leads to an increased catecholamine formation. Therefore, we measured the urinary catecholamines and their metabolites associated with vaping and smoking, or no tobacco use. Healthy adults 18-45 yoa who use tobacco products were asked to vape for every 30sec for 10min, smoke 1 cigarette, or inhale through a straw (sham) prior to providing urine samples three times: before tobacco use (T0), one hour (T1), and two hours (T2) after tobacco exposure. Catecholamines and their metabolites were measured in urine samples containing internal standards analyzed on a LC/MS/MS. Participants were categorized by the product used at the study visit: combustible cigarettes (n=70), e-cigarette (n=171), or sham use of a straw (n=82). Log transformed catecholamines and metabolites, normalized to urinary creatinine, were compared among each tobacco use group. Generalized linear models were used to estimate the associations between the outcomes and tobacco product use at each time point, adjusting for age, race and sex seen in table 1. At T0, smoking was associated with lower metanephrine, 5-hydroxindole-3-acetic acid, and vanillymandelic acid. At T1, after vaping normetanephrine and 3-methoxytyramine, epinephrine and homovanillic acid were higher. After smoking, norepinephrine, dopamine, normetnephrine, epinephrine and homovanillic acid were higher at T1. Whereas at T2 there was lower 5-hydroxindole-3-acetic acid in e-cigarette users. Our findings that both vaping and smoking are associated with increased urinary catecholamines or their metabolites, suggesting that the use of either product could elevate CVD risk due to repeated sympathetic stimulation. Catecholamines could be useful as a biomarker of harm for tobacco use.
Abstract 18852: Machine Learning to Predict Atrial Fibrillation Recurrence Using Pulmonary Vein Morphology
Authors: Asaeikheybari Golnoush , El-Harasis Majd , Barnard John , Shoemaker M. Benjamin , Passman Rod S , Gupta Amit , viswanathan Vidya Sankar , Kim Hyun Su , Schilling Taylor , Telfer William , Tandon Animesh A , Harwood Samuel , Sun Han , Jin Alison , Chung Mina K , Madabhushi Anant
Published: December 2023

Introduction:
Predicting risk of recurrence and sites of recurrence after atrial fibrillation (AF) ablation help direct ablation strategies. While the left atrium (LA) has been implicated as a possible site of AF recurrence leading to ablation directed toward LA substrates, reconnection of pulmonary veins (PVs) has been observed as a mechanism of recurrence on repeat ablations.

Hypothesis:
Regions of statistical shape differences between AF recurrence (AF+) and non-recurrence patients (AF-) within the PV on a CT scan might be associated with sites of recurrence, that features extracted from these regions may be better predictors of AF recurrence.

Methods:
A Hierarchical Atlas construction method for PV branching shape analysis was developed. Patients with the median volume of LA plus PV in each cohort were selected as the templates. All CT scans in each cohort were registered to the cohort’s template. Then, each branch was individually registered to the branch’s template and resulting control points applied to the LA and other PV branches to maintain connectivity. This process was repeated with 6 iterations to better adjust branching. Two separate atlases of AF+ and AF- were constructed. The areas of significant shape differences on the PV, surfaces of interest (SOIs), between the two groups were obtained via a General Linear Model based t-test on the atlases. Normal and curvature-based features were extracted from SOI regions. A Gradient Boosting classifier was trained based on these features. Cross-validation and atlas construction involved 104 cases. 50 cases served as a holdout set.

Results:
The classifier trained on SOI features on CT scans achieved AUCs of 0.76 (cross-validation) and 0.74 (holdout set). SOIs include sites within the left superior PV and the right PV carina.

Conclusions:
This finding appears to suggest that SOI regions on PVs tend to be associated with recurrence and hence may be candidate sites for additional ablation for preventing recurrence of AF.
Abstract 18858: At Heart
,
a Progressive Web App for Women With Heart Disease: A Pilot Randomized Controlled Trial
Authors: Parry Monica , Clarke Hance , Bjørnnes Ann Kristin , Harvey Paula , Norris Colleen M , Pilote Louise , Price Jennifer , Spiteri DeBonis Vincenza , Hart Donna , Nickerson Nicole , O'Hara Arland
Published: December 2023

Introduction/Background:
At heart
’s novel core feature set includes a Heart Check, Wellness Check, and a Library, with an interactive Chatbot to manage its content and conversations.
at heart
is the first of its kind; there are no previous trials of an intervention rigorously developed and tested.
Goals/Aims:
The overall goal of this study was to develop and evaluate a digital health intervention for women with heart disease. Specific aims of the pilot randomized controlled trial (RCT) were to examine: 1) the feasibility of randomization, recruitment, and retention, 2) acceptability and barriers to implementation (including the symptom triage algorithms), and 3) engagement with the intervention.

Methods/Approach:
This was a two-group parallel single blind pilot RCT. Women greater than 18 years of age with heart disease were recruited, all women spoke and read English. Following completion of baseline measures, participants were randomized to either an intervention or a usual care group. Participants randomized to the intervention group used
at heart
for 3 months. Recruitment, retention, and adverse events were tracked and engagement was assessed using
Google Analytics
. Acceptability was assessed with a six-item modified Acceptability e-Scale (AES), yielding a total acceptability score of 6-30.

Results/Data:
A total of 98 women were assessed for eligibility, 18 were excluded. Eighty women were randomized, 40 allocated to usual care and 40 to receive the intervention. Attrition was low. Mean age was 57 years (SD 13), 32% (n=27) were employed full time, and 48% (n=41) had a post-secondary diploma/certificate. There were 226 heart checks; 1-15 per participant, most symptoms were triaged as low risk (n=176, 78%). There were 198 wellness checks, 1-12 per participant. The mean number of articles accessed in the library was 8 per participant. The mean acceptability score was 23.46 (SD 4.87), there were no barriers to implementation, and no adverse events were reported.

Conclusion(s):
The
at heart
intervention is feasible; women were engaged and reported high acceptability scores. A larger, powered RCT is necessary.
Abstract 18861: Therapeutic Targeting of
Rpl13a
-Small Nucleolar RNAs Mitigates Atherosclerosis in
Apoe
-/-
Mice
Authors: Elliott Brittany A , Wu Jiao-Hui , Zhang Lisheng , yin xinhe , Davis Jeffrey K , Wu Pei-Chen , Freedman Neil J , Holley Christopher L
Published: December 2023

Specific non-coding, small nucleolar (sno) RNAs encoded within introns of the
Rpl13a
gene elevate cellular levels of reactive oxygen species (ROS), and ROS are known to aggravate atherosclerosis (athero). We found that genetic deficiency of
Rpl13a
-snoRNAs reduces brachiocephalic artery athero in
Apoe
-/-
mice by 50%. We therefore tested the hypothesis that athero could be reduced by acute pharmacologic intervention targeting
Rpl13a
-snoRNAs in
Apoe
-/-
mice. To that end, we injected male and female
Apoe
-/-
mice subcutaneously with 48 mg/kg antisense oligonucleotides (ASOs) targeting (a) the four
Rpl13a
-snoRNAs (ASO-snoRNA), or (b) green fluorescent protein (ASO-control). We tested two distinct strategies: (
i
) preventive, in which ASO injections and Western diet were started in 10-wk-old mice, with 4 weekly and 5 bi-weekly ASO treatments over 14 wk, then sacrifice; and (
ii
) “therapeutic,” in which ASO injections were started in 24-wk-old mice that had been fed Western diet for 14 wk and then were continued on Western diet with 6 weekly ASO treatments and then sacrificed. ASO injections were administered as indicated until 1 wk prior to sacrifice. Compared with saline-injected mice, ASO-control and ASO-snoRNA showed no hepatotoxicity (as assessed by serum ALT and AST). Compared with ASO-control, ASO-snoRNA administration for 6 wk reduced
Rpl13a
-snoRNA levels in the aorta and spleen by 54-80% for snoRNAs
U32a
,
U33
, and
U34
(RT-qPCR). In the “therapeutic” cohort, brachiocephalic artery cross-sectional athero was reduced by 38% in ASO-snoRNA-treated as compared with ASO-control-treated mice (n=7/group,
p
<0.03). Additionally, male ASO-snoRNA-treated mice exhibited a 98.1% decrease in circulating IL1-β transcripts (n=6-8/group, p<0.003). In the “preventive” cohort, aortic athero was reduced by 40% (13±5 vs 7±3 % aortic lesion area, n= 11-13/group,
p
<0.02) in ASO-snoRNA-treated as compared with ASO-control-treated mice. We conclude that therapeutic targeting of
Rpl13a
-snoRNAs with ASOs mitigates athero, both during the early and later stages of atherogenesis.
Abstract 18866: Binge Alcohol Drinking and Myocardial Infarction Mortality in the United States
Authors: Shorbaji Khaled , Alkelani Hiba , Kwon Jennie , Tedford Ryan J , Welch Brett , John Delgaizo , Kilic Arman
Published: December 2023

Introduction:
Although moderate alcohol intake is related to decrease all cause and ischemic heart disease mortality, intake of large amounts at a time remains controversial. Some studies have shown that binge drinking (BD) could have a protective effect.

Hypothesis:
The aim of this study is to study life-style risk factors associated with cardiovascular mortality in the U.S. population.

Methods:
The CDC National Environmental Public Health Tracking Network was used to identify age-adjusted mortality rate due to myocardial infarction (MMI) per county among people ≥35 years between 2018 and 2019. County's age-adjusted prevalence of current smoking (CS), binge alcohol drinking (BD), no-leisure time physical activity (NLTPA) and obesity were also identified as potential community life-style risk factors for MMI. Multivariable regression model predicting MMI rate was used to identify relationship between county MMI rate and those 4 life-style risk factors.

Results:
A total of 3106 counties were included in this study. Median county age-adjusted MMI rate was 61.00 [46.30, 85.38] per 100.000. Median county age-adjusted prevalence of CS was 19.80% [17.40, 22.80], BD 17.70% [15.70, 19.90], Obesity 35.60% [32.70, 38.10], and NLTPA 26.50% [23.30, 30.68]. In a multivariable regression model, CS prevalence above 20% increased the MMI rate by 9.83 (6.82 to 12.84, p<0.001) per 100.000, NLTPA prevalence above 29% increased the MMI rate by 21.57 (18.12 to 25.02, p<0.001) per 100.000, and obesity prevalence above 36% increased the MMI rate by 8.30 (5.54 to 11.07, p<0.001) per 100.000. On the other hand, BD prevalence above 18% was not associated with a significant increase in the MMI rate. [0.67 (-2.11 to 3.44, p=0.638) per 100.000].

Conclusions:
Community life-style risk-factors associated with myocardial infarction mortality include current smoking, no-leisure physical activity, and obesity. Alcohol binge drinking did not reduce myocardial infarction mortality rate.
Abstract 18874: Beyond the Beat: Predicting Frailty in Cardiovascular Patients Using Heart Rate Variability
Authors: Samuel Maryia , Arif Saleena Gul , Afilalo Jonathan
Published: December 2023

Introduction:
Frailty is the increased vulnerability to health issues due to age-related changes in body composition, mobility, and autonomic control. Heart rate variability (HRV) measures the oscillations between consecutive heartbeats. The LF/HF (low frequency/high frequency) ratio, a parameter of HRV, reflects the complex balance between sympathetic and parasympathetic control and cardiac autonomic regulation. Previous studies have linked the LF/HF ratio with frailty. Our goal was to determine if this association holds true in patients with cardiovascular disease (CVD) and if the LF/HF ratio can be used as a surrogate marker of frailty in these patients.

Methods:
A cross-sectional study was conducted at McGill University's Jewish General Hospital, involving adult patients at the ambulatory cardiology clinic. Resting HRV was evaluated for 2 minutes and 30 seconds using the Elite HRV CorSense monitor. Patients with electrical pacing, atrial fibrillation, or other arrhythmias during the visit were excluded. Frailty was assessed using the clinical frailty scale (CFS), with a CFS ≥ 5 indicating frailty. Routine comprehensive history and physical examinations were performed.

Results:
The cohort included 155 patients (66.9 ± 13 years, 68 females). Frailty prevalence was 15% (78.6 ± 10 years, 12 females), with a median LF/HF ratio of 0.37. The non-frail population (64.8 ± 12 years, 56 females) showed a significantly higher LF/HF ratio of 1.01 (p<0.001). This difference was driven by a decrease in LF power in the frail group (78.3 ms
2
) compared to the non-frail group (231.9 ms
2
, p=0.01). The LF/HF ratio correlated with frailty, decreasing by 0.437 for each unit increase in CFS (p<0.001). An LF/HF ratio of 0.37 best predicted frailty (54% sensitivity, 82% specificity, 0.77 ROC). Adjustment for age, sex, and comorbidities did not alter the association between LF/HF ratio and frailty.

Conclusions:
The LF/HF ratio exhibits an inverse correlation with frailty, making it a predictive tool for identifying CVD patients who may benefit from further frailty evaluation. Additionally, HRV parameters show potential for monitoring frailty and guiding interventions. However, additional research is needed to assess their practical implementation fully.
Abstract 18880: Ventricular Arrhythmia Prevalence and Burden in Patients With Third Generation Continuous Flow Left Ventricular Assist Devices
Authors: Tabaja Chadi , Arwa Younis , Taigen Tyler , Lee Justin , Chung Mina K , Barnard John , Nakhla Shady , Bhargava Mandeep , Higuchi Koji , Kanj Mohamed H , Sroubek Jakub , Saliba Walid I , Hussein Ayman , Finet J. Emanuel , Tang Wai Hong W , Wazni Oussama M , Santangeli Pasquale
Published: December 2023

Background:
Ventricular arrhythmias (VAs) are common in patients with left ventricular assist devices (LVADs). Little is known about the impact of third-generation LVADs (Heartmate 3, HM3) on VAs prevalence and burden.
Aims
:
To characterize the impact of HM3 LVAD implantation on VAs prevalence and burden in patients with advanced heart failure (HF) and implantable cardioverter-defibrillators (ICDs).

Methods:
We included consecutive patients with advanced HF and ICDs who received HM3 devices at our center between 2016 and 2022. The study outcomes were the prevalence of sustained VAs, defined as >30s VA episode detected by the ICD monitor zone or appropriately treated (ATP or shock), sustained VA burden (total number of episodes), and VA storm (≥3 appropriate ICD interventions in 24/h period). Data was collected over the 1 year before and after HM3 implantation.

Results:
A total of 321 patients were included (28% female, mean age 60±12 years, mean INTERMACS score 3±0.95). At 1 year follow-up after HM3 implantation, 27 patients died. A total of 128 patients (43%) had at least one sustained VA episode in the year before the HM3 implantation compared to 51 patients (17%) in the year following the HM3 (p<0.001 for comparison). The sustained VA burden decreased from a mean of 3.8 events per person-year (PPY) to a mean of 0.8 events PPY (p=0.005). Similarly, appropriate ICD therapy occurred in 123 patients (38%) before implantation and 46 patients (14%) after implantation (p<0.001). The burden of appropriate therapy was also reduced (from a mean of 2.57 events PPY to a mean 1.32 events PPY; p=0.03). The prevalence of VA storm was reduced from 19% to 8% (p<0.001).

Conclusions:
In patients with advanced HF and ICDs undergoing HM3 implantation, the prevalence of sustained VAs, VAs burden, appropriate ICD interventions, and VA storm were all significantly reduced in the year following HM3 implantation.
Abstract 18883: Inflammatory Bowel Disease is Not Significantly Associated With Cardiac Arrest in STEMI Patients
Authors: Rizk Alexander A , Faisaluddin Mohammed , Doumas Stavros , Kumar Ashwin , Dey Amit K , Dani Sourbha
Published: December 2023

Introduction:
Systemic inflammatory diseases, such as psoriasis, lupus, and rheumatoid arthritis, have exhibited a strong association with an increased incidence of cardiovascular events over a patient’s lifetime. However, there is limited information regarding outcomes, particularly cardiac arrest, in STEMI patients with concurrent IBD. Thus, our study aims to assess potential outcomes, including cardiac arrest, in STEMI patients with IBD, utilizing a nationally representative sample of adult individuals in the United States, with a specific focus on MACE and associated risk factors. Our study provides valuable insights into the cardiovascular implications and associated risk factors in this unique patient population.

Methods:
The US-based National Inpatient Sample was queried between 2015 and 2020 using ICD-10 codes for adults ≥ 18 years with STEMI with and without IBD. The adjusted odds ratio of index hospitalization outcomes was calculated using a multivariate logistic regression analysis.

Results:
Overall, 3,960 out of 898,525 (0.44%) STEMI patients reported a history of IBD. Patients with IBD were predominantly middle aged, white, and female compared to non-IBD patients. STEMI patients with IBD had similar CVD risk factors (specifically hypertension and obesity) than non-IBD patients (P > 0.05), however the prevalence of smoking and diabetes were lower in IBD patients (P < 0.001). Notably, STEMI patients with IBD had a lower prevalence of cardiac arrest compared to their non-IBD counterparts (P < 0.001). However on adjustment for baseline CVD risk factors and hospital characteristics, no significant difference was appreciated (P = 0.25) (Table 1).

Conclusions:
In a nationally representative adult US population IBD was not shown to confer an increased risk of cardiac arrest in patients with a history of STEMI. These findings underscore the need for further investigation to elucidate the complex relationship between IBD and cardiovascular outcomes.
Abstract 18914: Metabolomic Biomarker Profiling Improves Cardiovascular Risk Assessment for Patients on Statins: Evidence From 35000 Individuals From the United Kingdom
Authors: Julkunen Heli , Barrett Jeffrey , Lundgren Sara , Schut Kirsten , Kerminen Sini , Wurtz Peter
Published: December 2023

Introduction:
Identification of individuals at high cardiovascular risk even when using statins can guide second line therapy for primary prevention.

Hypothesis:
We addressed whether metabolomic biomarker profiling has utility in predicting onset of major adverse cardiovascular events (MACE) and heart failure among individuals already on statin therapy.

Methods:
Circulating lipids, fatty acids, amino acids, glycolysis metabolites and inflammation markers were measured by NMR metabolomics in ~275,000 individuals from UK Biobank. The study population was filtered to people using statins at blood sampling, comprising 34,971 individuals. During 10-year follow-up, 2156 first occurrence MACE events and 1753 heart failure hospitalisation events occured. Using multivariable regression modelling, we derived separate 10-year residual risk scores for the first onset of MACE and heart failure. We assessed the predictive improvements of adding the metabolomic biomarkers to established risk factors and routine cholesterol measurements.

Results:
Adding the metabolomic biomarkers to established risk factors and cholesterol measures improved AUC from 0.67 to 0.70 for 3-point MACE and from 0.68 to 0.71 for heart failure. Using only the metabolomic biomarkers from the low-cost NMR assay, along with age and sex, yielded a performance close to that of the full model, achieving AUC of 0.69 for 3-point MACE and 0.70 for heart failure. Substantial improvements were observed when looking at the high-risk tails of the risk scores. When comparing the highest risk decile to the remaining 90% of study population, adding the metabolomic biomarkers to established risk factors and cholesterols increased the hazard ratio from 2.2 (95% CI 1.9-2.6) to 2.8 (95% CI 2.4-3.3) for 3-point MACE and from 2.7 (95% CI 2.3-3.3) to 3.4 (95% CI 2.8-4.0) for heart failure, i.e. reaching comparable risk elevation as seen in familial hypercholesterolemia.

Conclusions:
Metabolomic biomarker profiling by a low-cost NMR assay enhanced prediction of incident MACE and heart failure beyond established risk factors for individuals already on statin therapy. This may complement the residual risk assessment in primary prevention settings and guide second line therapy to those with most benefit.
Abstract 18920: Left Atrial Function is Associated With Left Ventricular Mass in Women With Preserved Left Ventricular Ejection Fraction and Late Gadolinium Enhancement on Cardiac MRI
Authors: Bregasi Alda , sitticharoenchai patita , Lin Ben A , Pham Hien , Kukar Nina , Concepcion Jose R , Zalta Benjamin A. , Jacobi Adam H
Published: December 2023

Introduction:
Myocardial fibrosis detected by late gadolinium enhancement (LGE) on cardiac MRI may be related to conditions with increased left ventricular (LV) mass and diastolic dysfunction. Women have an increased incidence of LV diastolic dysfunction and poorer clinical outcomes compared to men.

Aim:
To examine gender-based associations between LV mass and left atrial total emptying fraction (LATEF), a surrogate for diastolic function, in patients with LGE on cardiac MRI.

Methods:
We analyzed 134 consecutive patients undergoing cardiac MRI and LGE sequences on a 1.5T GE scanner. LV mass and LV/LA volumes (indexed by BSA) were measured offline from cine SSFP images using Precession software. Presence of LGE was reported. Nonparametric analyses were performed.

Results:
40 patients with more than mild mitral regurgitation, pericardial disease, or LVEF <50% were excluded. 94 patients studied (49% women) had a median age of 51 years [IQR 38-67] with no gender-based difference. Median LV mass index (LVMi) for all patients was 69.5 g/m2 [IQR 57-82] and was higher in LGE vs no-LGE patients (p<0.001) and higher in men vs women (p<0.05). Median LATEF for all patients was 0.50 [IQR 0.41-0.54] and was lower in LGE vs no-LGE patients (p<0.001) with no gender-based difference. LVMi had a strong inverse correlation with LATEF for all patients and for the LGE group (r=-0.58, p<0.001 and r=-0.51, p<0.001 respectively). LVMi had a very strong inverse correlation with LATEF (r=-0.74, p<<0.001) in women with LGE and moderate inverse correlation in women with no-LGE (r=-0.45, p=0.02). LVMi had a moderate inverse correlation with LATEF in men with LGE (r=-0.48, p. <0.01) and no correlation in men with no-LGE (Figure).

Conclusions:
LA function inversely correlates with indexed LV mass, most strongly in women with LV LGE. Further exploration of these parameters may allow earlier detection of LV diastolic dysfunction and improved risk stratification.
Abstract 18921: Obstructive Sleep Apnea in the Presence of Heart Failure With Preserved Ejection Fraction is Associated With Low Arousal Threshold and Increased Sleep Fragmentation
Authors: Tolbert Thomas M , Mitter Sumeet S , lerakis stamatios , Adawi Ayham , Valencia Daphne , Mullins Anna , Parekh Ankit , Osorio Suarez Ricardo Miguel S , Ayappa Indu , Rapoport David M
Published: December 2023

Introduction:
Heart failure with preserved ejection fraction (HFpEF) is often accompanied by obstructive sleep apnea (OSA). The effects of HFpEF on OSA pathophysiology remain relatively unexplored. Pulmonary congestion and sympathetic nervous activity (SNA) may drive ventilatory control instability (high loop gain [LG]). Elevated SNA also theoretically predisposes sleep to easier interruption by breathing events of OSA, reflected by low arousal threshold (ArTH).

Hypothesis:
In comparison to patients with OSA alone, patients with both OSA and HFpEF have higher LG and lower ArTH.

Methods:
We reviewed records to include patients with 1) transthoracic echocardiography with EF>40% and left ventricular diastolic dysfunction by decreased age-adjusted e’ and/or left atrial volume index >28 mL/m
2
; 2) OSA by apnea-hypopnea index (AHI3A) ≥15 events/hour; and 3) raw polysomnography (PSG) data available for advanced signal analysis. LG and ArTH were estimated by Phenotyping Using Polysomnography (PUP), a MATLAB algorithm that quantifies pathophysiologic mechanisms of OSA using PSG data. Values in HFpEF+OSA patients were compared to values from research volunteers with OSA alone.

Results:
The HFpEF+OSA group included 21 patients. The OSA alone group included 43 research volunteers. LG was lower for HFpEF+OSA (0.63±18) compared to OSA alone (0.69±18), but the difference was not statistically significant. ArTH was significantly lower for HFpEF+OSA (117.0±15.9 %eupnea) compared to OSA alone (152.8±54.8 %eupnea, p = <0.001) and remained significant after adjustment for age, sex, and body mass index. ArTH was correlated with sleep efficiency (R = 0.43, p = <0.001) and negatively correlated with wake after sleep onset (R = -0.35, p =0.005).

Conclusions:
HFpEF is associated with low arousal threshold, which may contribute to sleep fragmentation. Our data did not confirm the hypothesis of greater breathing instability in patients with HFpEF and OSA compared to OSA alone.